Nonetheless, in a bizarre “we lost, but we won” propaganda campaign, the deniers are pulling out all the stops to spin this new diagnosis as a rejection of both “sex addiction” and “porn addiction.” Their assertion is nonsensical, as:

Neither the ICD-11 nor the DSM5 ever use the word “addiction” to describe an addiction – whether it be gambling addiction, heroin addiction, cigarette addiction or you name it. Both diagnostic manuals use the word “disorder” instead of “addiction” (i.e. “gambling disorder” “nicotine use disorder”, and so on). Thus, “sex addiction” and “porn addiction” could never have been rejected, because they were never under formal consideration in the major diagnostic manuals. Put simply, there will never be a “porn addiction” diagnosis, just as there will never be a “meth addiction” diagnosis. Yet both pathologies can be diagnosed using the ICD-11’s provisions.

Nearly 41 recent neuroscience-based studies have been published on chronic porn users and those with CSB. All 41 report brain, neuropsychological, or hormonal alterations that mirror those seen in studies on substance addicts.

The following screenshot, circulating on pro-porn propagandist’s social media accounts (created by Nicole Prause), features the core piece of purported “evidence” that the ICD-11 “rejected sex addiction and porn addiction.” Excerpting a 2014 Jon Grant commentary, and counting on short attention-spans, the propagandists expect you to read only what’s in the red boxes, hoping you will overlook what the paragraph actually states:

If you fell for the red-box illusion, you misread the above excerpt as:

…pornography viewing… questionable whether there is enough scientific evidence at this time to justify its inclusion as a disorder. Based on the limited current data, it would therefore seem premature to include it in the ICD-11.

Yet that’s just a lie. Here’s the Jon Grant 2014 paper: Impulse control disorders and “behavioural addictions” in the ICD-11. Read the entire paragraph and you will see that Jon Grant is talking about “Internet gaming disorder”not pornography. Grant believed it was questionable whether there was enough scientific evidence at that time to justify Internet Gaming Disorder’s inclusion as a disorder:

A third key controversy in the field is whether problematic Internet use is an independent disorder. The Working Group noted that this is a heterogeneous condition, and that use of the Internet may in fact constitute a delivery system for various forms of impulse control dysfunction (e.g., pathological game playing or pornography viewing). Importantly, the descriptions of pathological gambling and of compulsive sexual behaviour disorder should note that such behaviours are increasingly seen using Internet forums, either in addition to more traditional settings, or exclusively 22,23. The DSM-5 has included Internet gaming disorder in the section “Conditions for further study”. Although potentially an important behaviour to understand, and one certainly with a high profile in some countries 12, it is questionable whether there is enough scientific evidence at this time to justify its inclusion as a disorder. Based on the limited current data, it would therefore seem premature to include it in the ICD-11.

Without reading only the red squares, the above excerpt reveals that Jon Grant believes that internet pornography viewing can be an impulse control disorder, and it falls under the umbrella diagnosis of “Compulsive Sexual Behavior Disorder” (CSBD). This is the exact opposite of the “red square” illusion tweeted by the propagandists.

Even if Jon Grant had actually said that compulsive porn use could not be classified under Compulsive Sexual Behavior Disorders, it would be irrelevant as (1) the paper is over 4 years old, and (2) it’s just Grant’s two cents, not an official position paper by the World Health Organization. Moreover, a lot has changed in the intervening 4.5 years. By the way, Internet Gaming Disorder is now in WHO’s ICD-11, under addictive behaviors.

Compulsive sexual behavior (CSB), also referred to as sexual addiction or hypersexuality, is characterized by repetitive and intense preoccupations with sexual fantasies, urges, and behaviors that are distressing to the individual and/or result in psychosocial impairment.

Despite a few misleading rumors to the contrary, it is untrue that the WHO has rejected “porn addiction” or “sex addiction”. CSBD is an umbrella term that allows diagnoses of both “porn addiction” and “sex addiction” (as well as “hypersexuality” and “out-of-control sexual behavior”).

ANOTHER DAY, ANOTHER DECEPTIVE TACTIC

The day after YBOP posted the above section, porn addiction denier Nicole Prause stopped tweeting the deceptive “red square” screenshot and replaced it with an equally deceptive GIF where you can watch Nicole Prause search for “addiction” in the ICD-11 search box. Sure enough, the ICD system gives a few returns of “addiction” related to a few drugs, etc. Prause then lies, saying, “To be clear, ICD does use the term “addiction” extensively, but they specifically reject the term “addiction” for use with sex (or sex films).” Screenshot of Prause’s search:

KEY POINT: while the the word “addiction” (in red above) appears when searching – that word is nowhere to be found once you click on a disorder for an addictive drug. For example, consider “Disorders due to alcohol use”:

Due to the fierce politics surrounding the inclusion of “Compulsive sexual behavior disorder,” it is, for now, categorized under “Impulse control disorder,” just as gambling once was. This is controversial, and may change in the future, as explained by ICD insiders in this World Psychiatry paper.

Neuroscience and PSBs

In recent years, neuroscience discoveries about the reward system and human sexuality have shed new light on both problematic and healthy sexual behavior. As can be expected with any new paradigm, however, some doubtful neuroscience claims have also appeared in the media. As a neurosurgeon and the author of several papers on problematic sexual behavior and the appetite/reward mechanisms of the brain, I sometimes help to correct these misunderstandings. Here are a few examples that might be of interest to our readers.

Dopamine plays many benign roles in our physiology, such as facilitating movement and choices. However, all experts in the fields of addiction or neuroscience acknowledge the central role of dopamine in addiction.

In fact, addiction cannot develop without high, but brief, bursts of dopamine in response to an addictive substance or activity. As experts Volkow and Koob explained in a recent paper, these dopamine surges elicit reward signals at a cell receptor level, which then trigger so-called Pavlovian learning. The molecular mechanisms that facilitate this process appear similar for all forms of learning and memory. Repeated experiences of reward (for example, porn viewing) become associated with the stimuli in the user’s environment that precede them.

Interestingly, after repeated exposure to the same reward (in this example, porn), dopamine cells tend to fire more strongly in anticipation of viewing rather than in conjunction with actual viewing – although internet porn’s endless novelty means that using and anticipation are interwoven, in contrast with, say, a cocaine habit. As any addiction develops, cues and triggers, such as hearing a porn star’s name, time alone, or a mental state associated with past use (boredom, rejection, fatigue, etc.) can elicit conditioned, sudden surges of dopamine release. These surges then trigger cravings to use or even binge. Such conditioned responses may become deeply ingrained and can bring on strong cravings even long after someone quits using porn.

Although dopamine is sometimes thought of as a “pleasure molecule,” this is technically inaccurate. Dopamine drives seeking and searching for reward – the anticipation, the wanting. In some unfortunate people, this seeking deepens into the disorder known as addiction. The user’s desperate search for satiety (that eventually often proves fleeting or unattainable) progresses to the point of marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

However, addiction is now being defined not solely by this behavioral definition. It is also increasingly defined as a form of disordered reward learning. As Kauer and Malenka said, “addiction represents a pathological but powerful form of learning and memory.” This is why the American Society of Addiction Medicine (ASAM) redefined addiction as including both substances and behaviors. ASAM’s position is a recognition of the brain’s central role in driving what Marc Lewis called a “rut, a line of footprints in the neural flesh, which harden and become indelible.” (Lewis, Memoirs of an Addicted Brain, 2011).

ERROR #2 – “At a brain level sexual activity is no different from playing with puppies”

While playing with puppies might activate the reward system (unless you are a cat person), such activation doesn’t support the claim that all natural rewards are neurological equivalents. First, sexual arousal and orgasm induce far higher levels of dopamine and endogenous opioids than any other natural reward. Rat studies reveal that the dopamine levels occurring with sexual arousal equal those induced by the administration of morphine or nicotine.

Sexual arousal is also unique because it activates precisely the same reward system nerve cells as do addictive drugs. In contrast, there’s only a small percentage of nerve-cell activation overlap between addictive drugs and natural rewards such as food or water. Not surprisingly, researchers have also established that the natural reward of food does not cause the same persistent change in synaptic plasticity as sexual activity (Chen et al., 2008).

While far too complex to elucidate in detail, multiple temporary neurological and hormonal changes occur with orgasm that do not occur with any other natural rewards. These include decreased brain androgen receptors, increased estrogen receptors, increased hypothalamic enkephalins, and increased prolactin. For example, ejaculation mimics the effects of chronic heroin administration on reward system nerve cells (the ventral tegmental area, or VTA). Specifically, ejaculation temporarily shrinks the same dopamine producing nerve cells that shrink with chronic heroin use, leading to temporary down-regulation of dopamine in the reward center (nucleus accumbens).

A 2000 fMRI study compared brain activation using two different natural rewards, one of which was porn. Cocaine addicts and healthy controls viewed films of: 1) explicit sexual content, 2) outdoor nature scenes, and 3) individuals smoking crack cocaine. The results: cocaine addicts had nearly identical brain activation patterns when viewing porn and viewing cues related to their addiction. (Incidentally, both cocaine addicts and healthy controls had the same brain activation patterns for porn.) However, for both the addicts and controls, brain activation patterns when viewing nature scenes were completely different from the patterns when viewing for porn. In short, there are multiple biological reasons we experience an orgasm differently from playing with puppies or viewing sunsets. Millions of adolescent boys and increasingly girls are not just watching puppies on the Internet, and Mindgeek knows that to make billions in ad revenues you name a site “Pornhub,” not “PuppyHub!”

ERROR #3 – “The brain effects of today’s porn are no different than static porn of the past”

This claim implies that all porn is equally harmless. However, as the recent paper Park et al., 2016 points out, research demonstrates that video porn is significantly more sexually arousing than other forms of porn. (I know of no research on VR porn yet.) In addition, the ability to self-select material makes internet porn more arousing than pre-selected collections. Today’s porn user can also maintain or heighten sexual arousal by clicking to a novel scene, new video or fresh genre. Novel sexual visuals trigger greater arousal, faster ejaculation, and more semen and erection activity than familiar material.

Thus today’s digital porn, with its limitless novelty, potent delivery (hi-def video or virtual), and the ease with which the user can escalate to more extreme material, appears to constitute a “supranormal stimulus.” This phrase, coined by Nobel laureate Nikolaas Tinbergen, refers to an exaggerated imitation of a stimulus that a species has evolved to pursue due to its evolutionary salience, but which can evoke more of a neurochemical response (dopamine) than the stimulus it imitates.

Tinbergen originally found that birds, butterflies, and other animals could be duped into preferring artificial substitutes designed specifically to appear more attractive than the animal’s normal eggs and mates. Just as Tinbergen’s and Magnus’s ‘butterfly porn’ successfully competed for male attention at the expense of real females (Magnus, 1958; Tinbergen, 1951), so today’s porn is unique in its power to compete for users’ attention at the expense of real partners.

The three errors discussed above are typical of commentators anxious to ignore the brain’s central role in human volition, behavior, and emotion. One sexologist wrote, “There is brain science and neuroscience, but none of that applies to sexual science.” On the contrary, those educated in biology will increasingly understand the brain’s central role in every human activity. After all, both sexologists and neuroscientists alike should understand that the genitals take their marching orders from the brain, the primary sex organ.

Donald L. Hilton Jr, MD, FACS, FAANS is an adjunct associate professor of neurosurgery at the University of Texas Health Science Center at San Antonio, the director of the spine fellowship and the director of neurosurgical training at the Methodist Hospital rotation. He has authored numerous articles and speaks nationally and internationally on the neurobiology of porn use.

What do Prause, Ley, Kohut, and Perry present to counter the preponderance of empirical research? Distraction, irrelevant arguments, and a few cherry-picked outlier papers, which do not hold up to closer scrutiny. In a coordinated campaign, where all four authors cite each other, they argue that masturbation, not porn use, is the actual cause of both relationship problems and sexual dysfunctions. Their sole support for this remarkable assertion is a solitary paper by Samuel Perry. It did not contain accurate data on masturbation frequency, which means its claims are little more than an hypothesis at this point. There is no solid evidence to support their assertions that masturbation, not internet porn use, is the culprit, but there is much contradictory evidence (see above). Moreover, no urologist agrees with these sexologists that masturbation causes sexual dysfunction – and Prause contradicts herself in the commentary itself by also claiming that masturbation “appears to improve general health.”

Prause’s commentary is a unconvincing attempt to debunk many of the empirically well supported negative effects related to internet porn use. Prause promotes the idea that using porn is actually beneficial…for most everyone…at any age. Aside from the bits about porn being safe for kids (below), Prause’s commentary is little more than bits and pieces copied from three earlier Prause pieces, which YBOP has critiqued:

Two Highly Dubious Papers vs. Over 60 Studies

In lieu of rehashing the above critiques, we provide an example from Prause’s current commentary. Near the end Prause presents all of the supporting material she can muster to “prove” her assertion that porn use has no negative effects on sexual relationships. Prause offers only two dubious citations, while ignoring over 60 other studies (including 7 longitudinal studies) that undermine her latest commentary:

The primary hypothesis of the proposed model was a bit surprising given that a large, preregistered, replication attempt found no evidence for poorer relationship quality (attraction, love) in romantic partners attributable to VSS (Balzarini, Dobson, Chin, & Campbell, 2017). When asked directly, couples in relationships most commonly believe that their VSS viewing has no negative effects on their relationships and cite mostly positive effects (Kohut, Fisher, & Campbell, 2016). Further, others have failed to find direct effects of VSS on relationship satisfaction (except indirectly in men already low in intimacy; Veit, Štulhofer, & Hald, 2016). Many predictions of the proposed model appear already falsified by existing data. Such a model might be more useful to characterize the role of masturbation or sexual desire discrepancies.

Prause’s two supporting citations (which she repeatedly tweets) come from the lab of close friend and co-author Taylor Kohut. Neither is what it appears to be.

1) Study did not contain a representative sample. Whereas most studies show that a tiny minority of females in long-term relationships use porn, in this study 95% of the women used porn on their own. And 83% of the women had used porn since the beginning of the relationship (in some cases for years). Those rates are higher than in college-aged men! In other words, the researchers appear to have skewed their sample to produce the results they were seeking.

The reality? Data from the largestnationally representative US survey (General Social Survey) reported that only 2.6% of married women had visited a “pornographic website” in the last month. Data from 2000 – 2004 (for more see Pornography and Marriage, 2014). While these rates may seem low, keep in mind that (1) it asked only married women, (2) it represented all age groups, (3) it asked if porn-site use was “once a month or more,” while most studies ask “ever visited” or “ visited in the last year.”

2) Study did not correlate porn use with any variable assessing sexual or relationship satisfaction. Instead, the study employed “open ended” questionswhere the subjects could ramble on about porn. (It was qualitative rather than quantitative.) Then the researchers read the ramblings and decided, after the fact, what answers were “important,” and how to present (spin?) them in their paper. Then the researchers boldly suggested that all of the other studies on porn and relationships, which employed more established, scientific methodology and straightforward questions about porn’s effects, were flawed. Is this really science? The lead author Kohut’s website and his attempt at fundraising raise a few questions, as does his 2016 study where he claimed that using porn is related to greater egalitarianism & less sexism (a finding countered by nearly every other relevant study ever published).

This 2017 study attempted to replicate a 1989 study, which exposed men and women in committed relationships to erotic images of the opposite sex. The 1989 study found that men who were exposed to the nude Playboy centerfolds rated their partners as less attractive and reported less love for their partner. As the 2017 effort failed to replicate the 1989 findings, the authors insisted that the 1989 study got it wrong, and that porn use cannot diminish love or desire. However, the replication likely “failed” because our cultural environment has simply become more pornified and hardcore. The 2017 researchers didn’t recruit 1989 college students who grew up watching MTV after school. Instead their subjects grew up surfing PornHub for gang bang and orgy video clips.

In 1989 how many college students had seen an X-rated video? Not too many. How many 1989 college students spent every masturbation session, from puberty on, masturbating to multiple hardcore clips in one session? None. The reason for the 2017 results is evident: brief exposure to a still image of a Playboy centerfold is a big yawn compared to what college men in 2017 have been watching for years. Even the authors admitted the generational differences with their first caveat – but didn’t alter their conclusions or headlines in the press:

First, it is important to point out that the original study was published in 1989. At the time, exposure to sexual content may not have been as available, whereas today, exposure to nude images is relatively more pervasive, and thus being exposed to a nude centerfold may not be enough to elicit the contrast effect originally reported. Therefore, the results for the current replication studies may differ from the original study due to differences in exposure, access, and even acceptance of erotica then versus now.

In a rare instance of unbiased prose even David Ley felt compelled to point out the obvious:

It may be that the culture, men, and sexuality have substantially changed since 1989. Few adult men these days haven’t seen pornography or nude women—nudity and graphic sexuality are common in popular media, from Game of Thrones to perfume advertisements, and in many states, women are permitted to go topless. So it’s possible that men in the more recent study have learned to integrate the nudity and sexuality they see in porn and everyday media in a manner which doesn’t affect their attraction or love for their partners. Perhaps the men in the 1989 study had been less exposed to sexuality, nudity, and pornography.

Keep in mind that this experiment doesn’t mean internet porn use hasn’t affected men’s attraction for their lovers. It just means that looking at “centerfolds” has no immediate impact these days. Many men report radical increases in attraction to partners after giving up internet porn. And, of course, there is also the longitudinal peer-reviewed evidence cited here demonstrating the deleterious effects of porn viewing on relationships.

Put simply, Prause is unsuccessfully attempting to counter the preponderance of studies linking porn use to divorce, breakups, and poorer sexual and relationship satisfaction.

Finally, it’s important to note that the authors of the second authority she cites are colleagues of Taylor Kohut at the University of Western Ontario. This group of researchers, headed by William Fisher, has been publishing questionable studies, which consistently produce results that on the surface appear to counter the vast literature linking porn use to myriad negative outcomes (outlying studies). Moreover, both Kohut and Fisher played major, questionable roles in defeating Motion 47 in Canada.

Prause Says Porn May be Just Fine For Kids

Unlike any previous Prause papers, Prause here delves into porn use by children as if she is an expert in this arena. (Prause has never published a paper about adolescents and pornography use, and she does not treat patients, even though she currently holds a California psychology license.)

Sometimes she seems almost reasonable; other times this commentary reads as if it’s written by the Free Speech Coalition. A few samples from Prause’s “Youth Masturbate for Pleasure” section, in which she artfully goes back and forth between porn use and masturbation, keeping readers off-guard:

Curiously, Leonhardt et al. presumed the effects of VSS on children must be negative and require familial mitigation (“[family] can mitigate the influence of sexual media,” “Healthy exploration within primary source relationships”). Realistically, parental reactions to childhood masturbation, with or without VSS, are often shaming and potentially harmful (Gagnon, 1985)….

Similarly, Leonhardt et al. (2018) write as though youth are passive, non-sexual agents, describing that they “are exposed to a sexual script” and “children receive their formative exposure.” This ignores that youth can be active sexual agents, experience sexual motivation for pleasure, and masturbate……

Leonhardt et al. (2018) present the “age of exposure” as a risk factor (in “Formativeness” section) for negative outcomes. Yet, earlier viewing of VSS has a number of positive associations……

Identifying methods to support the benefits of VSS viewing by youth who found VSS, while mitigating the risks (Livingstone & Helsper, 2009), appears more consistent with the arguments to contextualize VSS experience advanced by Leonhardt et al. (2018)…..

Prause’s “Youth Masturbate for Pleasure” section is fairly long, yet she only cites four cherry-picked pornography studies to support her position that internet porn use is no big deal for kids. Three of the four studies concern themselves with porn viewers 1) being slightly more comfortable with viewing genitals, and 2) marginally better at identifying genital structures.

Increased access to the Internet by adolescents has created unprecedented opportunities for sexual education, learning, and growth. Conversely, the risk of harm that is evident in the literature has led researchers to investigate adolescent exposure to online pornography in an effort to elucidate these relationships. Collectively, these studies suggest that youth who consume pornography may develop unrealistic sexual values and beliefs. Among the findings, higher levels of permissive sexual attitudes, sexual preoccupation, and earlier sexual experimentation have been correlated with more frequent consumption of pornography….

Nevertheless, consistent findings have emerged linking adolescent use of pornography that depicts violence with increased degrees of sexually aggressive behavior. The literature does indicate some correlation between adolescents’ use of pornography and self-concept. Girls report feeling physically inferior to the women they view in pornographic material, while boys fear they may not be as virile or able to perform as the men in these media. Adolescents also report that their use of pornography decreased as their self-confidence and social development increase. Additionally, research suggests that adolescents who use pornography, especially that found on the Internet, have lower degrees of social integration, increases in conduct problems, higher levels of delinquent behavior, higher incidence of depressive symptoms, and decreased emotional bonding with caregivers.

The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

Prause’s omission of these important meta-studies raises questions as to whether her contrary assertions are made objectively. As impartiality is the bedrock of scholarly literature, consider the following page: Is Nicole Prause Influenced by the Porn Industry?

Mustanski asks, “What was the purpose of the study?” And Prause replies, “Our study tested whether people who report such problems [problems with regulating their viewing of online erotica] look like other addicts from their brain responses to sexual images.”

But the study did not compare brain recordings from persons having problems regulating their viewing of online erotica to brain recordings from drug addicts and brain recordings from a non-addict control group, which would have been the obvious way to see if brain responses from the troubled group look more like the brain responses of addicts or non-addicts.

Instead, Prause claims that their within-subject design was a better method, where research subjects serve as their own control group. With this design, they found that the EEG response of their subjects (as a group) to erotic pictures was stronger than their EEG responses to other kinds of pictures. This is shown in the inline waveform graph (although for some reason the graph differs considerably from the actual graph in the published article).

So this group who reports having trouble regulating their viewing of online erotica has a stronger EEG response to erotic pictures than other kinds of pictures. Do addicts show a similarly strong EEG response when presented with their drug of choice? We don’t know. Do normal, non-addicts show a response as strong as the troubled group to erotica? Again, we do not know. We don’t know whether this EEG pattern is more similar to the brain patterns of addicts or non-addicts.

The Prause research team claims to be able to demonstrate whether the elevated EEG response of their subjects to erotica is an addictive brain response or just a high-libido brain response by correlating a set of questionnaire scores with individual differences in EEG response. But explaining differences in EEG response is a different question from exploring whether the overall group’s response looks addictive or not. The Prause group reported that the only statistically significant correlation with the EEG response was a negative correlation (r=-.33) with desire for sex with a partner. In other words, there was a slight tendency for subjects with strong EEG responses to erotica to have lower desire for sex with a partner. How does that say anything about whether the brain responses of people who have trouble regulating their viewing of erotica are similar to addicts or non-addicts with a high libido?

Two months later Johnson published this psychology Today blog post which he posted about under Prause’s interview.

My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports
higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice.

How could she draw a conclusion that is the opposite of the actual results? I think it could be do to her preconceptions–what she expected to find. I wrote about this elsewhere.
http://www.psychologytoday.com/blog/cui-bono/201308/preconceptions-may-color-conclusions-about-sex-addiction

When I first conceived this blog post and began to compose it about a month ago, my original intention was to describe in exquisite detail the specific ways in which I saw the proponents of opposite sides of the debate exaggerating or overextending their arguments beyond the actual data in the study. I subsequently changed my mind when I observed a firestorm of emotionally-charged rhetoric erupting among the debate participants. Not arguments about what the data logically implied, but ad hominem threats, including threats of legal action. I saw a PT blog post disappear, apparently because one of the parties demanded that it be taken down. I even received a couple of angry emails myself because one of the parties had heard that I had raised questions about the proper interpretation of the research in question in a scientific forum.

So, I have decided to quietly tip-toe out of the room. I have also decided to go ahead and post here what I had already composed a month ago, simply to present an example of my empirical claim that science is not a purely objective enterprise, and that actual scientists can become very personally and emotionally involved in their work. The controversy in question is also an excellent example of a common trend among U.S. researchers to overestimate soft-science results.

It seems to me that passion is a double-edged sword. On the good side, passion for a subject means the person is willing to invest a lot of time and energy on that subject. Why would someone study something unless he or she had a passion for it?

On the other hand, if the passionate person already has his/her mind made up, all of that passionate energy is going to be directed toward one possibility, right or wrong. And when wrong, passion leads to blindness to the truth.

I am likely to stay out of these debates and let the empirical researchers decide.

As you mention, this debate since rife with agendas. However, linking a science debate to some random dude trying to sell books? How is this an improvement? I also think you missed the point of the study…all people show the pattern. This group (1) looks exactly like everyone else, and (2) just to be sure, the brain measure wasn’t related to any measure of hypersexuality (though it was to desire for sex with a partner). I’m not sure why it wasn’t related to desire to masturbate too, although the authors administered the whole scale and do talk about why that might be.

If the point of the study was to show that “all people” (not just alleged sex addicts) show a spike in P300 amplitude when viewing sexual images, you are correct–I do not get the point, because the study employed only alleged sex addicts. If the study *had* employed a non-addict comparison group and found that they also showed the P300 spike, then the researchers would have had a case for their claim that the brains of so-called sex addicts react that same as non-addicts, so maybe there is no difference between alleged addicts and non-addicts. Instead, the study showed that the self-described addicts showed the P300 spike in response to their self-described addictive “substance” (sexual images), just like cocaine addicts show a P300 spike when presented with cocaine, alcoholics show a P300 spike when presented with alcohol, etc.

As for what the correlations between P300 amplitude and other scores show, the only significant correlation was a *negative* correlation with desire for sex with a partner. In other words, the stronger the brain response to the sexual image, the *less* desire the person had for sex with a real person. This sounds to me like the profile of someone who is so fixated on images that s/he has trouble connecting sexually with people in real life. I would say that this person has a problem. Whether we want to call this problem an “addiction” is still arguable. But I do not see how this finding demonstrates the *lack* of addiction in this sample.

To my knowledge, my post did not contain links to a random dude trying to sell books. The Porn Study Critiques site contains contributions by a number of individuals interested in the debate, and I invited readers to judge for themselves which arguments might have merit. I did not notice any book advertisements on that site.

Okay, I’m going to be optimistic and assume neither the author of this PT post nor the authors of the research article are intentionally biased. On the one hand, that change (sexual pics having the highest change) I would estimate has been replicated by at least 100 laboratories in controls. It’s extremely stable. Also, controls are exactly people who are on the low/absent end of the construct of interest. The regressions (not correlations) conducted, could be critiqued for not having the low end well-represented, but the range of the construct appears represented. Finally, we don’t know that a control wasn’t collected. Science is slow. It could be coming before you throw the scientist out with the biohazard (ha!)

That said, there are many questions this study raises:
1. How would a person with other sexual problems respond?
2. What will change with different kinds of pictures?
3. What about films?

The bigger question, though, is…why did it take so long to get a study like this done in the first place? Really, both the pro and con crowd should be embarrassed by the poor level of science in this area.

There are actual scientists blogging about this topic if you need better links. This is a blogger who appears to have no credentials and made many mistakes in their “review”. I’ll even give you the pro-addiction science links. PT shouldn’t be relying on crappy reviews like that. Perhaps it was meant to be a commentary on bias that the PT author chose only a pro-addiction link only from a non-scientist blogger?

I may have biases on this topic, but if I do, I am not aware of them, and I certainly am not intentionally trying to skew the debate one way or another. So you are right to assume that any bias in my writing is not intentional. Whether the authors of the study are intentionally biased, I cannot say. I do suspect that they wanted their study to demonstrate that the neural responses of alleged sex addicts are indistinguishable from the responses of non-addicts in order to discredit the concept of sex addiction. They certainly were willing to report in the popular media that their study cast grave doubt on the concept of sex addiction. But of course without a control group of non-addicts to show that neural responses between the two groups are indistinguishable, the claim of discrediting the concept of sex addiction is premature.

You say we don’t know if a control group was run. In response to this question in a scientific forum, the researchers said they did not have a control group because none was needed, that their subjects served as their own control in their within-subjects design. I found that response unintelligible because the only comparisons made with their within-subjects design were the P300 responses to the different types of photographic stimuli. This demonstrated that the P300 spike was higher for the erotic images was higher than for the other images. But whether the relative magnitude is similar to or different from self-described non-addicts, we don’t know. If there are findings from hundreds of laboratories on this one, the authors could have made that comparison. But they didn’t.

If the researchers had included self-described non-addicts in their study, the statistically significant negative correlation between P300 amplitude and desire for sex with a partner could have been even stronger than the coefficient they reported. The correlation they found was probably reduced due to restriction of range in P300 amplitude. So they did themselves a disservice by not including a more diverse sample that included people who did not report problems regulating their online viewing of erotica.

I use the terms regression and correlation interchangeably. Whether one conducts a simple bivariate regression or one of the forms of multiple regression, it’s all a version of the general linear model. We abbreviate the Pearson correlation coefficient with the small letter r, which stands for regression. Let’s not get side-tracked on irrelevancies.

Because I do not have a stake in the sex addiction debate, I don’t want to pick only on this anti-addiction research study and not the pro-addiction critics of the study. The blog to which I linked contains reviews which are certainly biased in their own way, although again I do not want to speculate on whether the bias is intentional or not. I was asked by the author of one of the reviews on this site to look at his critique before it was published, so I did, and I described what I thought was correct and incorrect in the critique. He followed some, but not all, of my suggestions for revising his critique. So, yes, there are mistakes in the review because not all of my suggestions were followed. I pointed to this blog merely as a starting place for the issues that are being debated. If you could provide links to higher-quality commentary (either pro-addiction or anti-addiction), that would be a great service to those in the audience who are interested in the concept of sex addiction.

As I said, my major interest is in the psychological factors that affect the conduct and interpretation of scientific research, more than the concept of sex addiction per se. Perhaps it was easier for me to point to the site of a true believer in the concept of sex addiction to illustrate possible psychological factors affecting the interpretation of research than to a more staid, neutral site maintained by professional sex researchers. If there is such an allegedly non-biased site (pro- or anti-addiction), I’d love to get the URL to see for myself whether it is indeed unbiased. Finding a non-biased discussion of sex addiction would be a first for me.

Indeed. Sounds to me like the author perhaps ought to have paid greater heed to your feedback, prior to publishing.

Hate to point out what is so painfully obvious here, buuuut, it can be safely said that if the major debate surrounding one’s publishing is it’s validity, rather than it’s content, there is a definite problem.

Yes, if the problem is not obvious, it should be. This problem is not unique, though, to this particular topic. It runs rampant in academic psychology.

Psychologists get so much training in critical thinking, by which I mean looking for flaws in research studies and generating alternative interpretations of results, that most of us have developed hypertrophy of our critical function and atrophy of our constructive, creative function. Psychologists will endlessly pick at flaws in the methodology of studies that do not support the content they already believe. This an indication of a problem with the discipline of psychology as a whole. No study is absolutely methodologically perfect, even published studies that have undergone thorough review. It’s one thing to be able to find flaws in studies that draw conclusions you don’t like; it is another to design and conduct a study the produces unequivocal support for an alternative view.

Eh, not to get sidetracked but “We abbreviate the Pearson correlation coefficient with the small letter r, which stands for regression” definitely not. Regression locates the error differently than correlation. You can easily tell who actually read the study reviewed…if they say “correlation” they did not know what was done statistically (guy in your link made the same mistake). Don’t be that guy!

Anyway, I didn’t find a ton of scientific bloggers talking about this issue, but there were some really nice, more balanced reviews you could reference:
Other PT blogger and academic addictions guy:
http://www.psychologytoday.com/blog/addiction-in-society/201307/the-apocryphal-debate-about-sex-addiction

From the main guy trying to get hypersexuality into the DSM:
http://www.rory.net/pages/prausecritque.html

A guy who publishes on addiction, though not about this study:
http://www.sexologytoday.org/2012/03/steve-mcqueens-shame-valid-portrayal-of.html

Sure beats a random massage therapist in Oregon for their ability to more evenly critique. I don’t agree with all these either, of course, but that’s the point. These at least highlight the good and the bad, whereas the critique cited is actually factually false (e.g., the SNP authors collected and reported the entire SDI scale). It’s always better not to promote patently false information!

Let me quote from the study, which I actually did read prior to writing my post. From http://www.socioaffectiveneuroscipsychol.net/index.php/snp/article/view/20770/28995:

“Pearson’s correlations were calculated among the mean amplitudes measured in the P300 window and the self-report questionnaire data. The only correlation reaching significance was the difference score calculated between neutral and pleasant–sexual conditions in the P300 window with the desire for sex with a partner measure, r(52) = − 0.332, p =0.016.”

Yes, the researchers also conducted some multiple regression analyses, but you can see from the above quote that they computed Pearson correlation coefficients.

Furthermore, I maintain that regression and correlation are not two different things. I am aware that some people say that the correlation coefficient, r, is “merely” a quantitative index of the strength of the linear relationship between x and y, whereas regression refers to estimating either x or y in terms of the best-fitting line, either y’ = bx + a or x’ = by + a. But if we regress y on x, the optimal value for the slope, b, is r * Sy/Sx. Pick up any textbook on psychological statistics (e.g., Quinn McNemar) and read its discussion of correlation and regression.

Thank you for adding the additional references. I was familiar with Peele’s position (Stanton Peele is indeed a legitimate expert on the topic), and I had read Rory Reid’s piece, but not the James Cantor post (although I am familiar with and respect his thinking). These additional references are a service to those who want more information.

I’m frequently statistical consultant, and you’re embarrassing yourself. The errors term is different between regression and correlation…they are, in fact “two different things”. How on earth are you employed in a psych dept? At least stay away from my students!

I am not sure why you provided the quote from the study, “two-step hierarchical regressions were calculated,” when I already acknowledge that the researchers’ analyses included both multiple regression and the computation of Pearson correlations.

As I said, “Yes, the researchers also conducted some multiple regression analyses, but you can see from the above quote that they computed Pearson correlation coefficients.”

The reason that I pulled out the quote, “Pearson’s correlations were calculated . . . ” was because you implied that I and the critic did not read the study. You said, “You can easily tell who actually read the study reviewed…if they say ‘correlation’ they did not know what was done statistically (guy in your link made the same mistake).”

If you want to maintain that regression and correlation are two different things, be my guest. I have no idea who your students are because you are anonymous. Even if I did, I would not bother them. I am not embarrassed about my career as a psychologist; I hope that you find your career satisfying.

Ley’s blog post appeared 5 months before Prause’s EEG study was formally published. A month later (April 10th) Psychology Today editors unpublished Ley’s blog post due to controversies surrounding its unsubstantiated claims and Prause’s refusal to provided her unpublished study to anyone else. The day Steele et al., and its extensive associated press went public, Ley re-published his blog post. Ley changed the date of his blog post to July 25, 2013 – eventually closing comments.

Prause’s carefully orchestrated PR campaign resulted in worldwide media coverage with all the headlines claiming that sex addiction had been debunked(!). In TV interviews and in the UCLA press release Nicole Prause made two wholly unsupported claim about her EEG study:

Subjects’ brains did not respond like other addicts.

Hypersexuality (sex addiction) is best understood as “high desire.”

Neither of those findings are actually in Steele et al. 2013. In fact, the study reported the exact opposite of what Nicole Prause claimed:

What Steele et al., 2013 actually stated as its “brain findings”:

“the P300 mean amplitude for the pleasant–sexual condition was more positive than the unpleasant, and pleasant–non-sexual conditions”

Translation: Frequent porn users had greater cue-reactivity (higher EEG readings) to explicit sexual images relative to neutral pictures. This is exactly the same as what occurs when drug addicts are exposed to cues related their addiction.

“Larger P300 amplitude differences to pleasant sexual stimuli, relative to neutral stimuli, was negatively related to measures of sexual desire, but not related to measures of hypersexuality.”

Translation: Negatively means lower desire. Individuals with greater cue-reactivity to porn had lower desire to have sex with a partner (but not lower desire to masturbate). To put another way – individuals with more brain activation and cravings for porn preferred to masturbate to porn than have sex with a real person.

Seven peer-reviewed analyses of Steele et al. 2013

Over the intervening years many more neuroscience-based studies have been published (MRI, fMRI, EEG, neuropsychological, hormonal). All provide strong support for the addiction model as their findings mirror the neurological findings reported in substance addiction studies. The real experts’ opinions on porn/sex addiction can be seen in this list of 19 recent literature reviews & commentaries (all support the addiction model).

Seven of these peer-reviewed papers chose to analyze what Steele et al. 2013 actually report – not what Prause put forth in her PR campaign. All describe how the Steele et al. findings lend support to the porn addiction model. The papers are in alignment with the YBOP critique. Four of the papers also describe the study’s flawed methodology and unsubstantiated conclusions. Paper #1 is solely devoted to Steele et al., 2013. Papers 2-7 contain sections analyzing Steele et al., 2013. They are listed by date of publication:

The validity of an argument depends on the soundness of its premises. In the recent paper by Steele et al., conclusions are based on the initial construction of definitions relating to ‘desire’ and ‘addiction’. These definitions are based on a series of assumptions and qualifications, the limitations of which are acknowledged by the authors initially, but inexplicably ignored in reaching the firm conclusions the authors make. Yet, the firmness of these conclusions is unwarranted, not only as a result of conceptually problematic initial premises but also due to problematic methodology.

Consider, for instance, the concept of ‘sexual desire’. The first paragraph acknowledges that ‘sexual desires must be consistently regulated to manage sexual behaviors’, and must be controlled when either illegal (pedophilia) or inappropriate (infidelity). The paragraph ends with the inference that the term ‘sexual addiction’ does not describe a problematic entity per se, but that it merely describes a subset of individuals with high levels of desire.

The next paragraph references a paper by Winters et al., which suggests that ‘dysregulated sexuality … may simply be a marker of high sexual desire and the distress associated with managing a high degree of sexual thoughts, feelings, and needs’ (Winters, Christoff, & Gorzalka, 2010). It is based on these assumptions that Steele et al. then proceeds to question a disease model for this ‘distress’ associated with controlling sexual ‘desire’. For a comparison of different ‘desire’ templates, television viewing in children is used as an example. The last two sentences in this paragraph establish the premise that the rest of the paper then tries to prove:

Treatments focus on reducing the number of hours viewing television behaviorally without a disease overlay such as ‘television addiction’ and are effective. This suggests a similar approach might be appropriate for high sexual desire if the proposed disease model does not add explanatory power beyond merely high sexual desire. (Steele, Staley, Fong, & Prause, 2013)

Based on this comparison, that of desire to watch TV in children and desire for sex in adults, the authors then launch into a discussion on event-related potentials (ERPs) and a subsequent description of their study design, followed by results and discussion, and culminating in the following summary:

In conclusion, the first measures of neural reactivity to visual sexual and non-sexual stimuli in a sample reporting problems regulating their viewing of similar stimuli fail to provide support for models of pathological hypersexuality, as measured by questionnaires. Specifically, differences in the P300 window between sexual and neutral stimuli were predicted by sexual desire, but not by any (of three) measures of hypersexuality. (Steele et al., 2013)

With this statement the authors put forward the premise that high desire, even if it is problematic to those who experience it, is not pathologic, no matter the consequence.

Others have described significant limitations of this study. For instance, author Nicole Prause stated in an interview, ‘Studies of drug addictions, such as cocaine, have shown a consistent pattern of brain response to images of the drug of abuse, so we predicted that we should see the same pattern in people who report problems with sex if it was, in fact, an addiction’. John Johnson has pointed out several critical issues with this use of the Dunning et al. (2011) paper she cites as a basis for comparison with the Steele et al. paper. First, the Dunning et al. paper used three controls: abstinent cocaine users, current users, and drug naïve controls. The Steele et al. paper had no control group of any kind. Second, the Dunning et al. paper measured several different ERPs in the brain, including early posterior negativity (EPN), thought to reflect early selective attention, and late positive potential (LPP), thought to reflect further processing of motivationally significant material. Furthermore, the Dunning study distinguished the early and late components of the LPP, thought to reflect sustained processing. Moreover, the Dunning et al. paper distinguished between these different ERPs in abstinent, currently using, and healthy control groups. The Steele et al. paper, however, looked only at one ERP, the p300, which Dunning compared to the early window of the LLP. The Steele et al. authors even acknowledged this critical flaw in design: ‘Another possibility is that the p300 is not the best place to identify relationships with sexually motivating stimuli. The slightly later LPP appears more strongly linked to motivation’. Steel et al. admit that they are in fact not able to compare their results to the Dunning et al. study, yet their conclusions effectively make such a comparison. Regarding the Steele et al. study, Johnson summarized, ‘The single statistically significant finding says nothing about addiction. Furthermore, this significant finding is a negative correlation between P300 and desire for sex with a partner (r=−0.33), indicating that P300 amplitude is related to lower sexual desire; this directly contradicts the interpretation of P300 as high desire. There are no comparisons to other addict groups. There are no comparisons to control groups. The conclusions drawn by the researchers are a quantum leap from the data, which say nothing about whether people who report trouble regulating their viewing of sexual images have or do not have brain responses similar to cocaine or any other kinds of addicts’ (personal communication, John A. Johnson, PhD, 2013).

Although other serious deficiencies in this study design include lack of an adequate control group, heterogeneity of study sample, and a failure to understand the limitations of the ability of the P300 to qualitatively and quantitatively discriminate and differentiate between ‘merely high sexual desire’ and pathologically unwanted sexual compulsions, perhaps the most fundamental flaw relates to the use and understanding of the term ‘desire’. It is clear that in constructing this definitional platform, the authors minimize the concept of desire with the word ‘merely’. Desire, as related to biological systems in the context of sexuality, is a complex product of mesencephalic dopaminergic drive with telencephalic cognitive and affective mediation and expression. As a primal salience factor in sex, dopamine is increasingly recognized as a key component in sexual motivation, which has been widely conserved in the evolutionary tree (Pfaus, 2010). Genes relating to both the design and expression of sexual motivation are seen across phyla and also span intra-phyla complexity. While there are obvious differences between sex, food seeking, and other behaviors, which are essential to evolutionary fitness, we now know there are similarities in the molecular machinery from which biologically beneficial ‘desire’ emanates. We now know that these mechanisms are designed to ‘learn’, in a neural connecting and modulating way. As Hebb’s law states, ‘Neurons that fire together, wire together’. We became aware of the brain’s ability to alter its structural connectivity with reward learning in early studies relating to drug addiction, but have now seen neuronal reward-based learning with such seemingly diverse natural desires relating to sex and salt craving.

Definitions relating to desire are important here; biological salience, or ‘wanting’, is one thing, whereas we consider ‘craving’ to have more ominous implications as it is used in the literature relating to drug addiction and relapse. Evidence demonstrates that craving states relating to appetites for biologically essential necessities such as salt and sex invoke – with deprivation followed by satiation – a neuroplastic process involving a remodeling and arborizing of neuronal connections (Pitchers et al., 2010; Roitman et al., 2002). Notably, a desperate desire is effected by craving states associated with conditions that portend the possible death of the organism such as salt deficiency, which induces the animal to satiate and avoid death. Drug addiction in humans, interestingly, can affect a comparable craving leading to a similar desperation to satiate in spite of the risk of death, an inversion of this elemental drive. A similar phenomenon occurs with natural addictions as well, such as the individual with morbid obesity and severe cardiac disease continuing to consume a high fat diet, or one with a sexual addiction continuing to engage in random sexual acts with strangers despite an elevated probability of acquiring sexually transmitted diseases such as HIV and hepatitis. That gene sets driving signaling cascades essential to this craving conundrum are identical for both drug addiction and the most basic of natural cravings, salt, supports a hijacking, usurping role for addiction (Liedtke et al., 2011). We also better understand how complex systems associated with and effecting these changes involve genetic molecular switches, products, and modulators such as DeltaFosB, orexin, Cdk5, neural plasticity regulator activity-regulated cytoskeleton-associated protein (ARC), striatally enriched protein tyrosine phosphatase (STEP), and others. These entities form a complex signaling cascade, which is essential to neural learning.

What we experience affectively as ‘craving’, or very ‘high desire’, is a product of mesencephalic and hypothalamic impetus which projects to, participates in, and is part of cortical processing resulting from this convergence of conscious and unconscious information. As we demonstrated in our recent PNAS paper, these natural craving states ‘likely reflect usurping of evolutionary ancient systems with high survival value by the gratification of contemporary hedonic indulgences’ (Liedtke et al., 2011, PNAS), in that we found that these same salt ‘craving’ gene sets were previously associated with cocaine and opiate addiction. The cognitive expression of this ‘desire’, this focus on getting the reward, the ‘craving’ to experience satiation again is but a conscious ‘cortical’ expression of a deeply seated and phyolgenetically primitive drive originating in the hypothalamic/mesencephalic axis. When it results in an uncontrolled and – when expressed – destructive craving for a reward, how do we split neurobiological hairs and term it ‘merely’ high desire rather than addiction?

The other issue relates to immutability. Nowhere in the Steele et al. paper is there a discussion as to why these individuals have ‘high desire’. Were they born that way? What is the role, if any, of environment on both qualitative and quantitative aspect of said desire? Can learning affect desire in at least some of this rather heterogeneous study population? (Hoffman & Safron, 2012). The authors’ perspective in this regard lacks an understanding of the process of constant modulation at both cellular and macroscopic levels. We know, for instance, that these microstructural changes seen with neuronal learning are associated with macroscopic changes as well. Numerous studies confirm the importance of plasticity, as many have compellingly argued: ‘Contrary to assumptions that changes in brain networks are possible only during critical periods of development, modern neuroscience adopts the idea of a permanently plastic brain’ (Draganski & May, 2008); ‘Human brain imaging has identified structural changes in gray and white matter that occur with learning … learning sculpts brain structure’ (Zatorre, Field, & Johansen-Berg, 2012).

Finally, consider again the author’s term ‘merely high sexual desire’. Georgiadis (2012) recently suggested a central dopaminergic role for humans in this midbrain to striatum pathway. Of all the natural rewards, sexual orgasm involves the highest dopamine spike in the striatum, with levels up to 200% of baseline (Fiorino & Phillips, 1997), which is comparable with morphine (Di Chiara & Imperato, 1988) in experimental models. To trivialize, minimize, and de-pathologize compulsive sexuality is to fail to understand the central biological role of sexuality in human motivation and evolution. It demonstrates a naiveté with regard to what is now an accepted understanding of current reward neuroscience, in that it pronounces sexual desire as inherent, immutable, and uniquely immune from the possibility of change either qualitatively or quantitatively. Even more critically, however, as illustrated by the Steele et al. paper, is that this myopic dogma fails to comprehend the truth that neuroscience now tells us that ‘high desire’, when it results in compulsive, unwanted, and destructive behavior, is ‘merely’ an addiction.

Excerpt critiquing Steele et al., 2013 (Citation 25 is Steele et al.)

Our findings suggest dACC activity reflects the role of sexual desire, which may have similarities to a study on the P300 in CSB subjects correlating with desire [25]. We show differences between the CSB group and healthy volunteers whereas this previous study did not have a control group. The comparison of this current study with previous publications in CSB focusing on diffusion MRI and the P300 is difficult given methodological differences. Studies of the P300, an event related potential used to study attentional bias in substance use disorders, show elevated measures with respect to use of nicotine [54], alcohol [55], and opiates [56], with measures often correlating with craving indices. The P300 is also commonly studied in substance-use disorders using oddball tasks in which low-probability targets are frequently mixed with high-probability non-targets. A meta-analysis showed that substance-use-disordered subjects and their unaffected family members had decreased P300 amplitude compared to healthy volunteers [57]. These findings suggest substance-use disorders may be characterized by impaired allocation of attentional resources to task-relevant cognitive information (non-drug targets) with enhanced attentional bias to drug cues. The decrease in P300 amplitude may also be an endophenotypic marker for substance-use disorders. Studies of event-related potentials focusing on motivation relevance of cocaine and heroin cues further report abnormalities in the late components of the ERP (>300 milliseconds; late positive potential, LPP) in frontal regions, which may also reflect craving and attention allocation [58]–[60]. The LPP is believed to reflect both early attentional capture (400 to 1000 msec) and later sustained processing of motivationally significant stimuli. Subjects with cocaine use disorder had elevated early LPP measures compared to healthy volunteers suggesting a role for early attentional capture of motivated attention along with attenuated responses to pleasant emotional stimuli. However, the late LPP measures were not significantly different from those in healthy volunteers [61]. The generators of the P300 event-related potential for target-related responses is believed to be the parietal cortex and cingulate [62]. Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions.

Excerpt critiquing Steele et al., 2013 (citation 303):

An EEG study on those complaining of problems regulating their viewing of internet pornography has reported the neural reactivity to sexual stimuli [303]. The study was designed to examine the relationship between ERP amplitudes when viewing emotional and sexual images and questionnaire measures of hypersexuality and sexual desire. The authors concluded that the absence of correlations between scores on hypersexuality questionnaires and mean P300 amplitudes when viewing sexual images “fail to provide support for models of pathological hypersexuality” [303] (p. 10). However, the lack of correlations may be better explained by arguable flaws in the methodology. For example, this study used a heterogeneous subject pool (males and females, including 7 non-heterosexuals). Cue-reactivity studies comparing the brain response of addicts to healthy controls require homogenous subjects (same sex, similar ages) to have valid results. Specific to porn addiction studies, it’s well established that males and females differ appreciably in brain and autonomic responses to the identical visual sexual stimuli [304, 305, 306]. Additionally, two of the screening questionnaires have not been validated for addicted IP users, and the subjects were not screened for other manifestations of addiction or mood disorders.

Moreover, the conclusion listed in the abstract, “Implications for understanding hypersexuality as high desire, rather than disordered, are discussed” [303] (p. 1) seems out of place considering the study’s finding that P300 amplitude was negatively correlated with desire for sex with a partner. As explained in Hilton (2014), this finding “directly contradicts the interpretation of P300 as high desire” [307]. The Hilton analysis further suggests that the absence of a control group and the inability of EEG technology to discriminate between “high sexual desire” and “sexual compulsion” render the Steele et al. findings uninterpretable [307].

Finally, a significant finding of the paper (higher P300 amplitude to sexual images, relative to neutral pictures) is given minimal attention in the discussion section. This is unexpected, as a common finding with substance and internet addicts is an increased P300 amplitude relative to neutral stimuli when exposed to visual cues associated with their addiction [308]. In fact, Voon, et al. [262] devoted a section of their discussion analyzing this prior study’s P300 findings. Voon et al. provided the explanation of importance of P300 not provided in the Steele paper, particularly in regards to established addiction models, concluding,

“Thus, both dACC activity in the present CSB study and P300 activity reported in a previous CSB study[303] may reflect similar underlying processes of attentional capture. Similarly, both studies show a correlation between these measures with enhanced desire. Here we suggest that dACC activity correlates with desire, which may reflect an index of craving, but does not correlate with liking suggestive of on an incentive-salience model of addictions.” [262] (p. 7)

So while these authors [303] claimed that their study refuted the application of the addiction model to CSB, Voon et al. posited that these authors actually provided evidence supporting said model.

Excerpt analyzing Steele et al., 2013 (citation 48):

A 2013 EEG study by Steele et al. reported higher P300 amplitude to sexual images, relative to neutral pictures, in individuals complaining of problems regulating their Internet pornography use [48]. Substance abusers also exhibit greater P300 amplitude when exposed to visual cues associated with their addiction [148]. In addition, Steele et al. reported a negative correlation between P300 amplitude and desire for sex with a partner [48]. Greater cue reactivity to Internet pornography paired with less sexual desire for partnered sex, as reported by Steele et al., aligns with the Voon et al. finding of “diminished libido or erectile function specifically in physical relationships with women” in compulsive Internet pornography users [31]. Supporting these findings, two studies assessing sexual desire and erectile function in “hypersexuals” and compulsive Internet pornography users reported associations between measures of hypersexuality, and reduced desire for partnered sex and sexual difficulties [15,30]. Additionally, the 2016 survey of 434 men who viewed Internet pornography at least once in the last three months reported that problematic use was associated with higher levels of arousabilty, yet lower sexual satisfaction and poorer erectile function [44]. These results should be viewed in light of the multiple neuropsychology studies that have found that sexual arousal to Internet pornography cues and cravings to view pornography were related to symptom severity of cybersex addiction and self-reported problems in daily life due to excessive Internet pornography use [52,53,54,113,115,149,150]. Taken together, multiple and varied studies on Internet pornography users align with the incentive-salience theory of addiction, in which changes in the attraction value of an incentive correspond with changes in activation of regions of the brain implicated in the sensitization process [31,106]. To sum up, in alignment with our hypothesis, various studies report that greater reactivity toward pornographic cues, cravings to view, and compulsive pornography use are associated with sexual difficulties and diminished sexual desire for partners.

Event-related potentials (ERPs) have often been used as a physiological measure of reactions to emotional cues, e.g., [24]. Studies utilizing ERP data tend to focus on later ERP effects such as the P300 [14] and Late-Positive Potential (LPP) [7, 8] when investigating individuals who view pornography. These later aspects of the ERP waveform have been attributed to cognitive processes such as attention and working memory (P300) [25] as well as sustained processing of emotionally-relevant stimuli (LPP) [26]. Steele et al. [14] showed that the large P300 differences seen between viewing of sexually explicit images relative to neutral images was negatively related to measures of sexual desire, and had no effect on participants’ hypersexuality. The authors suggested that this negative finding was most probably due to the images shown not having any novel significance to the participant pool, as participants all reported viewing high volumes of pornographic material, consequently leading to the suppression of the P300 component. The authors went on to suggest that perhaps looking at the later occurring LPP may provide a more useful tool, as it has been shown to index motivation processes. Studies investigating the effect pornography use has on the LPP have shown the LPP amplitude to be generally smaller in participants who report having higher sexual desire and problems regulating their viewing of pornographic material [7, 8]. This result is unexpected, as numerous other addiction-related studies have shown that when presented with a cue-related emotion task, individuals who report having problems negotiating their addictions commonly exhibit larger LPP waveforms when presented images of their specific addiction-inducing substance [27]. Prause et al. [7, 8] offer suggestions as to why the use of pornography may result in smaller LPP effects by suggesting that it may be due to a habituation effect, as those participants in the study reporting overuse of pornographic material scored significantly higher in the amount of hours spent viewing pornographic material.

———–

Studies have consistently shown a physiological downregulation in processing of appetitive content due to habituation effects in individuals who frequently seek out pornographic material [3, 7, 8]. It is the authors’ contention that this effect may account for the results observed.

————

Future studies may need to utilise a more up-to-date standardised image database to account for changing cultures. Also, maybe high porn users downregulated their sexual responses during the study. This explanation was at least used by [7, 8] to describe their results which showed a weaker approach motivation indexed by smaller LPP (late positive potential) amplitude to erotic images by individuals reporting uncontrollable pornography use. LPP amplitudes have been shown to decrease upon intentional downregulation [62, 63]. Therefore, an inhibited LPP to erotic images may account for lack of significant effects found in the present study across groups for the “erotic” condition.

Excerpts analyzing Steele et al., 2013 (which is citation 68):

Klucken and colleagues recently observed that participants with CSB as compared to participants without displayed greater activation of the amygdala during presentation of conditioned cues (colored squares) predicting erotic pictures (rewards) [66]. These results are like those from other studies examining amygdala activation among individuals with substance use disorders and men with CSB watching sexually explicit video clips [1, 67]. Using EEG, Steele and colleagues observed a higher P300 amplitude to sexual images (when compared to neutral pictures) among individuals self-identified as having problems with CSB, resonating with prior research of processing visual drug cues in drug addiction [68, 69].

COMMENTS: In the above excerpt the authors of the current review are saying that Steele et al’s findings indicate cue-reactivity in frequent porn users. This aligns with the addiction model and cue-reactivity is a neuro-physiological marker for addiction. While Steele et al. spokesperson Nicole Prause claimed that the subjects’ brain response differed from other types of addicts (cocaine was the example given by Prause) – this was not true, and not reported anywhere in Steele et al., 201

Furthermore, habituation may be revealed through decreased reward sensitivity to normally salient stimuli and may impact reward responses to sexual stimuli including pornography viewing and partnered sex [1, 68]. Habituation has also been implicated in substance and behavioral addictions [73-79].

COMMENTS: In the above excerpt the authors of this review are referring to Steele et al’s finding of greater cue-reactivity to porn related to less desire for sex with a partner (but not lower desire to masturbate to porn). To put another way – individuals with more brain activation and cravings related to porn preferred to masturbate to porn than have sex with a real person. That’s less reward sensitivity to “partnered sex”, which is “normally salient stimuli”. Together these two Steele et al. findings indicate greater brain activity to cues (porn images), yet less reactivity to natural rewards (sex with a person). Both are hallmarks of an addiction.

Evidence of this neural activity signalizing desire is particularly prominent in the prefrontal cortex [101] and the amygdala [102,103], being evidence of sensitization. Activation in these brain regions is reminiscent of financial reward [104] and it may carry a similar impact. Moreover, there are higher EEG readings in these users, as well as the diminished desire for sex with a partner, but not for masturbation to pornography [105], something that reflects also on the difference in erection quality [8]. This can be considered a sign of desensitization. However, Steele’s study contains several methodological flaws to consider (subject heterogeneity, a lack of screening for mental disorders or addictions, the absence of a control group, and the use of questionnaires not validated for porn use) [106]. A study by Prause [107], this time with a control group, replicated these very findings. The role of cue reactivity and craving in the development of cybersex addiction have been corroborated in heterosexual female [108] and homosexual male samples [109].

COMMENTS: Steele et al., 2013 was touted in the media as evidence against the existence of porn/sex addiction. It wasn’t. As the above review by medical doctors explained, Steele et al. actually lends support to the existence of both porn addiction and porn use down-regulating sexual desire. How so? The study reported higher EEG readings (relative to neutral pictures) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction.

In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put it another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesperson Nicole Prause claimed that porn users merely had “high libido,” yet the results of the study say the exact opposite (subjects’ desire for partnered sex was dropping in relation to their porn use).

Excerpt analyzing Prause et al., 2015 (which is citation 87)

A study using EEG, conducted by Prause and colleagues, suggested that individuals who feel distressed about their pornography use, as compared to a control group who do not feel distress about their use of pornography, may require more/greater visual stimulation to evoke brain responses [87]. Hypersexual participants—individuals‘ experiencing problems regulating their viewing of sexual images’ (M=3.8 hours per week)—exhibited less neural activation (measured by late positive potential in the EEG signal) when exposed to sexual images than did the comparison group when exposed to the same images. Depending on the interpretation of sexual stimuli in this study (as a cue or reward; for more see Gola et al. [4]), the findings may support other observations indicating habituation effects in addictions [4]. In 2015, Banca and colleagues observed that men with CSB preferred novel sexual stimuli and demonstrated findings suggestive of habituation in the dACC when exposed repeatedly to the same images [88]. Results of the aforementioned studies suggest that frequent pornography use may decrease reward sensitivity, possibly leading to increased habituation and tolerance, thereby enhancing the need for greater stimulation to be sexually aroused. However, longitudinal studies are indicated to examine this possibility further. Taken together, neuroimaging research to date has provided initial support for the notion that CSB shares similarities with drug, gambling, and gaming addictions with respect to altered brain networks and processes, including sensitization and habituation.

COMMENTS: The authors of the current review agree with six other peer-reviewed papers (1, 2, 3,4,5, 6.): Lower EEG readings mean that subjects are paying less attention to the pictures. They were bored (habituated or desensitized). The lead author claims these results “debunk porn addiction”, but other researchers disagree with her over-the-top assertions. You have to ask yourself – “What legitimate scientist would claim that their lone anomalous study has debunked a well established field of study?”

FOR ADDED CONTEXT, THE FULL REVIEW

Abstract

Purpose of review: The current review summarizes the latest findings concerning neurobiological mechanisms of compulsive sexual behavior disorder (CSBD)and provides recommendations for future research specific to the diagnostic classification of the condition.

Recent findings: To date, most neuroimaging research on compulsive sexual behavior has provided evidence of overlapping mechanisms underlying compulsive sexual behavior and non-sexual addictions. Compulsive sexual behavior is associated with altered functioning in brain regions and networks implicated in sensitization, habituation, impulse dyscontrol, and reward processing in patterns like substance, gambling, and gaming addictions. Key brain regions linked to CSB features include the frontal and temporal cortices, amygdala, and striatum, including the nucleus accumbens.

Summary: Despite much neuroscience research finding many similarities between CSBD and substance and behavioral addictions, the World Health Organization included CSBD in the ICD-11 as an impulse-control disorder. Although previous research has helped to highlight some underlying mechanisms of the condition, additional investigations are needed to fully understand this phenomenon and resolve classification issues surrounding CSBD.

Introduction

Compulsive sexual behavior (CSB) is a debated topic that is also known as sexual addiction, hypersexuality, sexual dependence, sexual impulsivity, nymphomania, or out-of-control sexual behavior [1-27]. Although precise rates are unclear given limited epidemiological research, CSB is estimated to affect 3-6% of the adult population and is more common in men than women [28-32]. Due to the associated distress and impairment reported by men and women with CSB [4-6, 30, 33-38], the World Health Organization (WHO) has recommended including Compulsive Sexual Behavior Disorder(CSBD)in the forthcoming 11th edition of the International Classification of Diseases (6C72)[39]. This inclusion should help increase access to treatment for unserved populations, reduce stigma and shame associated with help-seeking, promote concerted research efforts, and increase international attention on this condition[40, 41].We acknowledge that over the last 20 years there have been varying definitions used to describe dysregulated sexual behaviors often characterized by excessive engagement in nonparaphilic sexual activities (e.g., frequent casual/anonymous sex, problematic use of pornography). For the current review, we will use the term CSB as an overarching term for describing problematic, excessive sexual behavior.

CSB has been conceptualized as an obsessive–compulsive-spectrum disorder, an impulse-control disorder, or addictive behavior [42, 43]. The symptoms of CSBD are like those proposed in 2010forthe DSM-5 diagnosis of hypersexual disorder [44]. Hypersexual disorder was ultimately excluded by American Psychiatric Association from DSM-5 for multiple reasons; the lack of neurobiological and genetic studies was among the most noted reasons [45, 46]. More recently, CSB has received considerable attention in both popular culture and social sciences, particularly given health disparities affecting at-risk and underserved groups. Despite the considerable increase in studies of CSB (including those studying “sexual addiction,” “hypersexuality,” “sexual compulsivity”), relatively little research has examined neural underpinnings of CSB [4, 36]. This article reviews neurobiological mechanisms of CSB and provides recommendations for future research, particularly as related to diagnostic classification of CSBD.

CSB as an Addictive Disorder

Brain regions involved in processing rewards are likely important for understanding the origins, formation, and maintenance of addictive behaviors [47]. Structures within a so-called ‘reward system’ are activated by potentially reinforcing stimuli, such as addictive drugs in addictions. A major neurotransmitter involved in processing rewards is dopamine, particularly within the mesolimbic pathway involving the ventral tegmental area (VTA) and its connections with the nucleus accumbens (NAc), as well as the amygdala, hippocampus, and prefrontal cortex [48]. Additional neurotransmitters and pathways are involved in processing rewards and pleasure, and these warrant considerations given that dopamine has been implicated to varying degrees in individual drug and behavioral addictions in humans [49-51].

According to the incentive salience theory, different brain mechanisms influence motivation to obtain reward (‘wanting’) and the actual hedonic experience of reward (‘liking’) [52]. Whereas ‘wanting’ may be closely related to dopaminergic neurotransmission in the ventral striatum (VStr) and orbitofrontal cortex, networks dedicated to creating wanting motivations and pleasurable feelings are more complex [49, 53, 54].

VStr reward-related reactivity has been studied in addictive disorders such as alcohol, cocaine, opioid use disorders, and gambling disorder[55-58]. Volkow and colleagues describe four important components of addiction: (1) sensitization involving cue reactivity and craving, (2) desensitization involving habituation, (3) hypofrontality, and (4) malfunctioning stress systems[59]. Thus far, research of CSB has largely focused on cue reactivity, craving, and habituation. The first neuroimaging studies of CSB were focused on examining potential similarities between CSB and addictions, with a specific focus on the incentive salience theory that is based on preconscious neural sensitization related to changes in dopamine-related motivation systems[60]. In this model, repeated exposure to potentially addictive drugs may change brain cells and circuits that regulate the attribution of incentive salience to stimuli, which is a psychological process involved in motivated behavior. Because of this exposure, brain circuits may become hypersensitive (or sensitized), thereby contributing to the development of pathological levels of incentive salience for target substances and their associated cues. Pathological incentive motivation (‘wanting’) for drugs may last for years, even if drug use is discontinued. It may involve implicit (unconscious wanting) or explicit (conscious craving) processes. The incentive salience model has been proposed to potentially contribute to the development and maintenance of CSB [1, 2].

Data support the incentive salience model for CSB. For example, Voon and colleagues examined cue-induced activity in the dorsal anterior cingulate cortex (dACC) –Vstr –amygdala functional network [1].Men with CSB as compared to those without showed increased VStr, dACC, and amygdala responses to pornographic video clips. These findings in the context of the larger literature suggest that sex and drug-cue reactivity involve largely overlapping regions and networks[61, 62]. Men with CSB as compared to those without also reported higher wanting (subjective sexual desire) of pornography stimuli and lower liking which is consistent with an incentive salience theory[1]. Similarly, Mechelmans and colleagues found that men with CSB as compared to men without showed enhanced early attentional bias towards sexually explicit stimuli but not to neutral cues [2]. These findings suggest similarities in enhanced attentional bias observed in studies examining drug cues in addictions.

In 2015, Seok and Sohn found that among men with CSB as compared to those without, greater activity was observed in the dorsolateral prefrontal cortex (dlPFC), caudate, inferior supramarginal gyrus of the parietal lobe, dACC, and thalamus in response to sexual cues[63]. They also found that the severity of CSB symptoms was correlated with cue-induced activation of the dlPFC and thalamus. In 2016, Brand and colleagues observed greater activation of the VStr for preferred pornographic material as compared to non-preferred pornographic material among men with CSB and found that VStr activity was positively associated with self-reported symptoms of addictive use of Internet pornography (assessed by the short Internet Addiction Test modified for cybersex (s-IATsex) [64, 65].

Klucken and colleagues recently observed that participants with CSB as compared to participants without displayed greater activation of the amygdala during presentation of conditioned cues (colored squares) predicting erotic pictures (rewards) [66]. These results are like those from other studies examining amygdala activation among individuals with substance use disorders and men with CSB watching sexually explicit video clips [1, 67].Using EEG, Steele and colleagues observed a higher P300 amplitude to sexual images (when compared to neutral pictures) among individuals self-identified as having problems with CSB, resonating with prior research of processing visual drug cues in drug addiction [68, 69].

In 2017, Gola and colleagues published results of a study using functional magnetic resonance imaging (fMRI) to examine Vstr responses to erotic and monetary stimuli among men seeking treatment for CSB and men without CSB [6]. Participants were engaged in an incentive delay task[54, 70, 71] while undergoing fMRI scanning. During this task, they received erotic or monetary rewards preceded by predictive cues. Men with CSB differed from those without in VStr responses to cues predicting erotic pictures, but not in their responses to erotic pictures. Additionally, men with CSB versus without CSB showed greater VStr activation specifically for cues predicting erotic pictures and not for those predicting monetary rewards. Relative sensitivity to cues (predicting erotic pictures vs. monetary gains) was found to be related to an increased behavioral motivation for viewing erotic images (‘wanting’), intensity of CSB, amount of pornography used per week, and frequency of weekly masturbation. These findings suggest similarities between CSB and addictions, an important role for learned cues in CSB, and possible treatment approaches, particularly interventions focused on teaching skills to individuals to successfully cope with cravings/urges [72]. Furthermore, habituation may be revealed through decreased reward sensitivity to normally salient stimuli and may impact reward responses to sexual stimuli including pornography viewing and partnered sex [1, 68]. Habituation has also been implicated in substance and behavioral addictions [73-79].

In 2014, Kuhn and Gallinat observed decreased VStr reactivity in response to erotic pictures in a group of participants watching pornography frequently, when compared to participants watching pornography rarely[80].Decreased functional connectivity between the left dlPFC and right VStr was also observed. Impairment in fronto-striatal circuity has been related to inappropriate or disadvantageous behavioral choices irrespective of potential negative outcome and impaired regulation of craving in drug addiction [81, 82]. Individuals with CSBmay have reduced executive control when exposed to pornographic material [83, 84]. Kuhn and Gallinat also found that the gray matter volume of the right striatum(caudate nucleus), which has been implicated in approach-attachment behaviors and related to motivational states associated with romantic love, was negatively associated with duration of internet pornography viewing[80, 85, 86]. These findings raise the possibility that frequent use of pornography may decrease brain activation in response to sexual stimuli and increase habituation to sexual pictures although longitudinal studies are needed to exclude other possibilities.

A study using EEG, conducted by Prause and colleagues, suggested that individuals who feel distressed about their pornography use, as compared to a control group who do not feel distress about their use of pornography, may require more/greater visual stimulation to evoke brain responses [87]. Hypersexual participants—individuals‘ experiencing problems regulating their viewing of sexual images’ (M=3.8 hours per week)—exhibited less neural activation (measured by late positive potential in the EEG signal) when exposed to sexual images than did the comparison group when exposed to the same images. Depending on the interpretation of sexual stimuli in this study (as a cue or reward; for more see Gola et al. [4]), the findings may support other observations indicating habituation effects in addictions [4].In 2015, Banca and colleagues observed that men with CSB preferred novel sexual stimuli and demonstrated findings suggestive of habituation in the dACC when exposed repeatedly to the same images [88]. Results of the aforementioned studies suggest that frequent pornography use may decrease reward sensitivity, possibly leading to increased habituation and tolerance, thereby enhancing the need for greater stimulation to be sexually aroused. However, longitudinal studies are indicated to examine this possibility further. Taken together, neuroimaging research to date has provided initial support for the notion that CSB shares similarities with drug, gambling, and gaming addictions with respect to altered brain networks and processes, including sensitization and habituation.

CSB as an Impulse-Control Disorder?

The category of “Impulse-Control Disorders Not Elsewhere Classified” in DSM-IV was heterogeneous in nature and included multiple disorders that have since been re-classified as being addictive (gambling disorder) or obsessive-compulsive-related (trichotillomania) in DSM-5[89, 90]. The current category in the DSM-5 focuses on disruptive, impulse-control and conduct disorders, becoming more homogeneous in its focus by including kleptomania, pyromania, intermittent explosive disorder, oppositional defiant disorder, conduct disorder, and antisocial personality disorder[90]. The category of impulse-control disorders in the ICD-11includes these first three disorders and CSBD, raising questions regarding the most appropriate classification. Given this context, how CSBD relates to the transdiagnostic construct of impulsivity warrants additional consideration for classification as well as clinical purposes.

Impulsivity may be defined as a, “predisposition towards rapid, unplanned reactions to internal or external stimuli with diminished regard to the negative consequences to the impulsive individual or others” [91]. Impulsivity has been associated with hypersexuality [92]. Impulsivity is a multidimensional construct with different types (e.g., choice, response) that may have trait and state characteristics [93-97]. Different forms of impulsivity may be assessed via self-report or via tasks. They may correlate weakly or not all, even within the same form of impulsivity; importantly, they may relate differentially to clinical characteristics and outcomes [98]. Response impulsivity maybe measured by performance on inhibitory control tasks, such as the stop signal or Go/No-Go tasks, whereas choice impulsivity may be assessed through delay discounting tasks [94, 95, 99].

Data suggest differences between individuals with and without CSB on self-report and task-based measures of impulsivity [100-103]. Furthermore, impulsivity and craving seem to be associated with the severity of symptoms of dysregulated pornography use, such as loss of control [64, 104]. For instance, one study found interacting effects of levels of impulsivity measured by self-report and behavioral tasks with respect to cumulative influences on symptom severity of CSB [104].

Among treatment-seeking samples, 48% to 55% of people may exhibit high levels of generalized impulsivity on Barratt Impulsiveness Scale [105-107]. In contrast, other data suggest that some patients seeking treatment for CSB do not have other impulsive behaviors or comorbid addictions beyond their struggles with sexual behaviors which is consistent with findings from a large online survey of men and women suggesting relatively weak relations between impulsivity and some aspects of CSB (problematic pornography use) and stronger relations with others (hypersexuality) [108, 109]. Similarly, in a study using different measures of individuals with problematic pornography use(mean time of weekly pornography use = 287.87 minutes) and those without (mean time of weekly pornography use = 50.77 minutes) did not differ on self-reported (UPPS-P Scale) or task-based (Stop Signal Task)measures of impulsivity [110].Further, Reid and colleagues did not observe differences between individuals with CSB and healthy controls on neuropsychological tests of executive functioning (i.e., response inhibition, motor speed, selective attention, vigilance, cognitive flexibility, concept formation, set shifting),even after adjusting for cognitive ability in analyses [103]. Together, findings suggest that impulsivity may link most strongly to hypersexuality but not to specific forms of CSB like problematic pornography use. It raises questions about CSBD’s classification as an impulse-control disorder in the ICD-11 and highlights the need for precise assessments of different forms of CSB. This is particularly important since some research indicates that impulsivity and subdomains of impulse-control disorder differ on conceptual and pathophysiological level [93, 98, 111].

CSB as an Obsessive-Compulsive-Spectrum Disorder?

One condition (trichotillomania) classified as an impulse-control disorder in DSM-IV has been reclassified with obsessive-compulsive disorder (OCD) as an obsessive-compulsive and related disorder in DSM-5[90]. Other DSM-IV impulse-control disorders like gambling disorder exhibit significant differences from OCD, supporting their classification in separate categories [112]. Compulsivity is a transdiagnostic construct that involves, “the performance of repetitive and functionally impairing overt or covert behavior without adaptive function, performed in a stereotyped or habitual fashion, either according to rigid rules or as a means to avoid negative consequences”[93]. OCD exhibits high levels of compulsivity; however, so do substance addictions and behavioral addictions like gambling disorder [98]. Traditionally, compulsive and impulsive disorders were construed as lying along opposite ends of a spectrum; however, data suggest the constructs as being orthogonal with many disorders scoring high on measures of both impulsivity and compulsivity [93, 113]. Regarding CSB, sexual obsessions have also been described as time-consuming and interfering and may relate theoretically to OCD or to OCD-related features [114].

Recent studies assessing obsessive-compulsive features using the Obsessive-Compulsive Inventory –Revised (OCI-R) did not show elevations among individuals with CSB [6, 37, 115]. Similarly, a large online survey found aspects of compulsivity only weakly related to problematic pornography use[109]. Together, these findings do not show strong support for considering CSB as an obsessive-compulsive-related disorder. Neural features underlying compulsive behaviors have been described and overlap across multiple disorders [93]. Further studies using psychometrically validated and neuroimaging methods in larger clinical treatment seeking samples are needed to examine further how CSBD may relate to compulsivity and OCD.

Structural Neural Changes among CSB Individuals

Thus far, most neuroimaging studies have focused on functional alterations in individuals with CSB, and results suggest that CSB symptoms are linked to specific neural processes[1, 63, 80]. Although task-based studies have deepened our knowledge about regional activation and functional connectivity, additional approaches should be used.

White-or gray-matter measures have been studied in CSB [102, 116]. In 2009, Miner and colleagues found that individuals with CSB as compared to those without displayed higher superior frontal region mean diffusivity and exhibited poorer inhibitive control. In a study of men with and without CSB from 2016, greater left amygdala volume was observed in the CSB group and relatively reduced resting-state functional connectivity was observed between the amygdala and dlPFC [116]. Reduction of brain volumes in the temporal lobe, frontal lobe, hippocampus, and amygdala were found to be related to the symptoms of hypersexuality in patients with dementia or Parkinson’s disease [117, 118]. These seemingly opposing patterns of amygdala volume relating to CSB highlight the importance of considering co-occurring neuropsychiatric disorders in understanding the neurobiology of CSB.

In 2018, Seok and Sohn used voxel-based morphometry (VBM) and resting-state connectivity analysis to examine gray-matter and resting-state measures in CSB [119]. Men with CSB showed significant gray-matter reduction in the temporal gyrus. Left superior temporal gyrus (STG) volume was negatively correlated with the severity of CSB (i.e., Sexual Addiction Screening Test-Revised [SAST ] and Hypersexual Behavior Inventory [HBI] scores)[120, 121]. Additionally, altered left STG-left precuneus and left STG-right caudate connectivities were observed. Lastly, results revealed a significant negative correlation between severity of CSB and functional connectivity of the left STG to the right caudate nucleus.

While the neuroimaging studies of CSB have been illuminating, little is still known about alternations in brain structures and functional connectivity among CSB individuals, particularly from treatment studies or other longitudinal designs. Integration of findings from other domains (e.g., genetic and epigenetic) will also be important to consider in future studies. Additionally, findings directly comparing specific disorders and incorporating transdiagnostic measures will allow for collection of important information that could inform classification and intervention development efforts currently underway.

Conclusions and Recommendations

This article reviews scientific knowledge regarding neural mechanisms of CSB from three perspectives: addictive, impulse-control, and obsessive-compulsive. Several studies suggest relationships between CSB and increased sensitivity for erotic rewards or cues predicting these rewards, and others suggest that CSB is related to increased cue-conditioning for erotic stimuli [1, 6, 36, 64, 66]. Studies also suggest that CSB symptoms are associated with elevated anxiety [34, 37,122]. Although gaps exist in our understanding of CSB, multiple brain regions (including frontal, parietal and temporal cortices, amygdala, and striatum) have been linked to CSB and related features.

CSBD has been included in the current version oftheICD-11as an impulse-control disorder [39]. As described by the WHO, ‘Impulse-control disorders are characterized by the repeated failure to resist an impulse, drive, or urge to perform an act that is rewarding to the person, at least in the short-term, despite consequences such as longer-term harm either to the individual or to others, marked distress about the behaviour pattern, or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning’ [39]. Current findings raise important questions regarding the classification of CSBD. Many disorders characterized by impaired impulse-control are classified elsewhere in the ICD-11 (for example, gambling, gaming, and substance-use disorders are classified as being addictive disorders) [123].

Currently, CSBD constitutes a heterogeneous disorder, and further refinement of CSBD criteria should distinguish between different subtypes, some of which may relate to the heterogeneity of sexual behaviors problematic for individuals [33, 108, 124]. Heterogeneity in CSBD may in part explain seeming discrepancies which are noticeable across studies. Although neuroimaging studies find multiple similarities between CSB and substance and behavioral addictions, additional research is needed to fully understand how neurocognition relates to the clinical characteristics of CSB, especially with respect to sexual behaviors subtypes. Multiple studies have focused exclusively on problematic use of pornography which may limit generalizability to other sexual behaviors. Further, inclusion/exclusion criteria for CSB research participants have varied across studies, also raising questions regarding generalizability and comparability across studies.

Future Directions

Several limitations should be noted with respect to current neuroimaging studies and be considered when planning future investigations (see Table 1). A primary limitation involves small sample sizes that are largely white, male, and heterosexual. More research is needed to recruit larger, ethnically diverse samples of men and women with CSB and individuals of different sexual identities and orientations. For example, no systematic scientific studies have investigated neurocognitive processes of CSB in women. Such studies are needed given data linking sexual impulsivity to greater psychopathology in women as compared to men and other data which suggest gender-related differences in clinical populations with CSB [25, 30]. As women and men with addictions may demonstrate different motivations (e.g., relating to negative versus positive reinforcement) for engaging in addictive behaviors and show differences in stress and drug-cue responsivity, future neurobiological studies should consider stress systems and related processes in gender-related investigations of CSBD given its current inclusion in the ICD-11 as a mental health disorder [125, 126].

Similarly, there is also a need to conduct systematic research focusing on ethnic and sexual minorities to clarify our understanding of CSB among these groups. Screening instruments for CSB have been mostly tested and validated on white European men. Moreover, current studies have focused predominantly on heterosexual men. More research examining clinical characteristics of CSB among gay and bisexual men and women is needed. Neurobiological research of specific groups (transgender, polyamorous, kink, other) and activities (pornography viewing, compulsive masturbation, casual anonymous sex, other) is also needed. Given such limitations, existing results should be interpreted cautiously.

Direct comparison of CSBD with other disorders (e.g., substance use, gambling, gaming, and other disorders)is needed, as is incorporation of other non-imaging modalities (e.g., genetic, epigenetic) and use of other imaging approaches. Techniques like positron emission tomography could also provide important insight into neurochemical underpinnings of CSBD.

The heterogeneity of CSB may also be clarified through careful assessment of clinical features that may be obtained in part from qualitative research like focus group ordiary assessment methods [37]. Such research could also provide insight into longitudinal questions like whether problematic pornography use may lead to sexual dysfunction, and integrating neurocognitive assessments into such studies could provide insight into neurobiological mechanisms. Further, as behavioral and pharmacological interventions are formally tested for their efficacies in treating CSBD, integration of neurocognitive assessments could help identify mechanisms of effective treatments for CSBD and potential biomarkers. This last point may be particularly important because the inclusion of CSBD in the ICD-11 will likely increase the number of individuals seeking treatment for CSBD. Specifically, the inclusion of CSBD in the ICD-11 should raise awareness in patients, providers, and others and potentially remove other barriers (e.g., reimbursement from insurance providers) that may currently exist for CSBD.

Introduction

This critique has two parts: Part 1 exposes how Nicole Prause, Marty Klein and Taylor Kohut completely misrepresent their solitary bit of “evidence” to support the article’s core falsehood – that “compulsive pornography viewing” was excluded from the new ICD-11 “Compulsive Sexual Behavior Disorder” diagnosis. Part 2 exposes the startling omissions, false claims, research misrepresentations, and cherry-picked data littering the Prause/Klein/Kohut article. (Note: Most of the article’s cherry-picked data and misrepresentations are recycled from this 2016 Prause “Letter to the editor” that YBOP thoroughly dismantled 2 years ago: Critique of: Letter to the editor “Prause et al. (2015) the latest falsification of addiction predictions”, 2016.)

The deniers of porn addiction are agitated because the latest version of the World Health Organization’s medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for diagnosing what is commonly referred to as ‘porn addiction’ or ‘sex addiction’. It’s called “Compulsive Sexual Behavior Disorder” (CSBD). Nonetheless, in a bizarre “We lost, but we won” propaganda campaign, the deniers have been pulling out all the stops to spin this new diagnosis as a rejection of both “sex addiction” and “porn addiction.”

Not satisfied with the false narrative claiming a “rejection of addiction,” veteran porn-addiction deniers Nicole Prause, Marty Klein and Taylor Kohut have taken their propaganda to new levels in this July 30, 2018 Slate article: “Why Are We Still So Worried About Wat­­ching Porn?” Without supplying any evidence beyond mere opinions, the Prause/Klein/Kohut triumvirate asserts that WHO has officially excluded pornography viewing from the “Compulsive Sexual Behavior Disorder” diagnosis:

With no support, and zero logic, Prause/Klein/Kohut would have us believe that the most common compulsive sexual behavior – compulsive pornography use – has been axed from the WHO’s new diagnostic manual edition (the ICD-11). The hollowness of the authors’ campaign is apparent for many reasons, some of the most obvious of which are:

Multiple studies show that at least 80% of people with compulsive sexual behaviour (hypersexuality) report compulsive internet pornography use.

Most of the recent 40 neuroscience-based studies (on which the WHO relied in its decision to include CSBD) have been done on internet pornography viewers­ – so it is silly to suggest that the WHO intended to exclude pornography viewing but forgot to specify it.

Before we get to a detailed evaluation of the deniers’ remarks, let’s be clear: There is neither proclamation nor vague allusion in any WHO literature that could be interpreted as excluding pornography users. Similarly, no WHO spokesperson has ever hinted that a CSBD diagnosis excludes pornography use. Here’s the CSBD diagnosis in its entirety taken directly from the ICD-11 manual:

Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.

Do you see anything about excluding pornography? What about excluding compulsively visiting prostitutes? Was any particular sexual behavior at all excluded? Of course not. The Prause/Klein/Kohut article cites no official WHO communication, and quotes no WHO spokesperson or working-group member. The article is little more than propaganda peppered with a handful of cherry-picked studies that are either misrepresented or not what they appear to be. (More below.)

If you have any doubts about the true nature of the Prause/Klein/Kohut press campaign, carefully read this responsible article about compulsive sexual behavior disorder (CSBD). Unlike their Slate article, this July 27, 2018 article in “SELF” goes straight to the source. It quotes official WHO spokesperson Christian Lindmeier. Lindmeier is one of only four officials WHO spokespersons listed on this page: Communications contacts in WHO headquarters – and the only WHO spokesperson to have formally commented about CSBD! The SELF article also interviewed Shane Kraus, who was at the center of the ICD-11’s Compulsive Sexual Behavior Disorder (CSBD) working group. Excerpt with Lindmeir quotes makes it clear that WHO did not reject “sex addiction”:

In regards to CSBD, the largest point of contention is whether or not the disorder should be categorized as an addiction. “There is ongoing scientific debate on whether or not the compulsive sexual behavior disorder constitutes the manifestation of a behavioral addiction,” WHO spokesperson Christian Lindmeier tells SELF. “WHO does not use the term sex addiction because we are not taking a position about whether it is physiologically an addiction or not.”

Who are the authors of this article?

Who are the authors of this article?

Before reviewing the details below, it would be well to consider the mouthpieces of the brazen serving of propaganda in Slate. Its authors are not impartial observers. Their pro-porn agenda is plain.

Prause/Klein/Kohut misrepresent their one and only piece of so-called “evidence”

In the following paragraph Prause/Klein/Kohut mislead the reader about “addiction” in diagnostic manuals and lie about their one and only bit of “evidence” for pornography use being excluded from the ICD-11 CSBD diagnosis:

We are also accustomed to the shock when journalists learn that “pornography addiction” is actually not recognized by any national or international diagnostic manual. With the publication of the latest International Classification of Diseases (version 11) in June, the World Health Organization once again decided not to recognize sex-film viewing as a disorder. “Pornography viewing” was considered for inclusion in the “problematic Internet use” category, but WHO decided against its inclusion because of the lack of available evidence for this disorder. (“Based on the limited current data, it would therefore seem premature to include it in the ICD-11,” the organization wrote.) The common American standard, the Diagnostic and Statistical Manual, made the same decision in their latest version as well; there is no listing for porn addiction in DSM-5.

First, neither the ICD-11 nor the APA’s DSM-5 ever uses the word “addiction” to describe an addiction – whether it be gambling addiction, heroin addiction, cigarette addiction, or you name it. Both diagnostic manuals use the word “disorder” instead of “addiction” (i.e. “gambling disorder,” “nicotine use disorder,” and so on). Thus, “sex addiction” and “porn addiction” could never have been rejected, because they were never under formal consideration in the major diagnostic manuals. Put simply, there will never be a “porn addiction” diagnosis, just as there will never be a “meth addiction” diagnosis. Yet individuals with the signs and symptoms of consistent with either a “porn addiction” or a “methamphetamine addiction” can be diagnosed using the ICD-11’s provisions.

(1) The Jon Grant paper is over 4 years old. In fact, 32 of the 39 neurological studies on CSB subjects listed on this page were published since the 2014 Jon Grant paper.

(2) It’s just Grant’s two cents, and not an official position paper by the World Health Organization or the CSBD work-group.

(3) Most importantly, nowhere in the paper does it say that pornography use should be excluded from CSBD.In fact, Grant says the opposite: pornography use on the internet is a form of CSB! The word “pornography” is used only once in paper and here is what Grant has to say about it:

A third key controversy in the field is whether problematic Internet use is an independent disorder. The Working Group noted that this is a heterogeneous condition, and that use of the Internet may in fact constitute a delivery system for various forms of impulse control dysfunction (e.g., pathological game playing or pornography viewing). Importantly, the descriptions of pathological gambling and of compulsive sexual behaviour disorder should note that such behaviours are increasingly seen using Internet forums, either in addition to more traditional settings, or exclusively 22, 23.

There you have it, Prause/Klein/Kohut blatantly misrepresented the only bit of “evidence” they could muster (fact-check Slate?).

However, the misrepresentation of Grant’s 2014 paper, by Prause, has been occurring for at least a year. Prause created the following image, which has been passed around pro-porn propagandists’ social media accounts. It’s a doctored screenshot of the Jon Grant paragraph I excerpted above. Counting on Twitter-induced short attention-spans, the propagandists expect you to read only what’s in the red boxes, hoping you will overlook what the paragraph actually states:

If you fell for the red-box illusion, you misread the above excerpt as:

…pornography viewing… questionable whether there is enough scientific evidence at this time to justify its inclusion as a disorder. Based on the limited current data, it would therefore seem premature to include it in the ICD-11.

Now read the entire paragraph, and you will see that Jon Grant is talking about “Internet gaming disorder,”not pornography. Grant believed it was questionable whether there was enough scientific evidence at that time to justify Internet Gaming Disorder’s inclusion as a disorder. (Incidentally, 4 years later Gaming disorder is in the ICD-11 and the scientific support for it is vast.)

A third key controversy in the field is whether problematic Internet use is an independent disorder. The Working Group noted that this is a heterogeneous condition, and that use of the Internet may in fact constitute a delivery system for various forms of impulse control dysfunction (e.g., pathological game playing or pornography viewing). Importantly, the descriptions of pathological gambling and of compulsive sexual behaviour disorder should note that such behaviours are increasingly seen using Internet forums, either in addition to more traditional settings, or exclusively 22,23. The DSM-5 has included Internet gaming disorder in the section “Conditions for further study”. Although potentially an important behaviour to understand, and one certainly with a high profile in some countries 12, it is questionable whether there is enough scientific evidence at this time to justify its inclusion as a disorder. Based on the limited current data, it would therefore seem premature to include it in the ICD-11.

Without reading only the red squares, the above excerpt reveals that Jon Grant believes that internet pornography viewing can be an impulse control disorder that would fall under the umbrella diagnosis of “Compulsive Sexual Behavior Disorder” (CSBD). This is the exact opposite of the “red square” illusion tweeted by the propagandists.

What is Jon Grant saying 4 years later? Grant was a co-author on this 2018 paper announcing (and agreeing with) the inclusion of CSBD in the upcoming ICD-11: Compulsive sexual behaviour disorder in the ICD‐11. In a second 2018 article, “Compulsive sexual behavior: A nonjudgmental approach,” Grant says that Compulsive Sexual Behavior is also called “sex addiction” or “hypersexuality” (which have always functioned in the peer-reviewed literature as synonymous terms for any compulsive sexual behavior, including compulsive porn use):

Compulsive sexual behavior (CSB), also referred to as sexual addiction or hypersexuality, is characterized by repetitive and intense preoccupations with sexual fantasies, urges, and behaviors that are distressing to the individual and/or result in psychosocial impairment.

Despite a few misleading rumors to the contrary, it is untrue that the WHO has rejected “porn addiction” or “sex addiction”. Compulsive sexual behavior has been called by a variety of names over the years: “hypersexuality”, “porn addiction”, “sex addiction”, “out-of-control sexual behavior” and so forth. In its latest catalogue of diseases the WHO takes a step towards legitimizing the disorder by acknowledging “Compulsive Sexual Behaviour Disorder” (CSBD) as a mental illness. According to WHO expert Geoffrey Reed, the new CSBD diagnosis “lets people know they have “a genuine condition” and can seek treatment.”

The remainder of the Prause/Klein/Kohut article is devoted to persuading the reader that porn addiction is a myth and that internet porn use causes no problems. In addition, they imply that only the “sex negative” would dare to suggest that porn use could produce negative effects. In this section we furnish relevant Prause/Klein/Kohut excerpts followed by analysis of both the claim and references supplied to support the claim. Where appropriate we provide studies that counter their assertions.

A sample of the article’s numerous omissions:

Before we address each of the article’s major assertions, it’s important to reveal what Prause/Klein/Kohut chose to omit from their magnum opus. The lists of studies contain relevant excerpts and links to the original papers.

The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

22 studies from 7 different countries were analyzed. Consumption was associated with sexual aggression in the United States and internationally, among males and females, and in cross-sectional and longitudinal studies. Associations were stronger for verbal than physical sexual aggression, although both were significant. The general pattern of results suggested that violent content may be an exacerbating factor.

Increased access to the Internet by adolescents has created unprecedented opportunities for sexual education, learning, and growth. Conversely, the risk of harm that is evident in the literature has led researchers to investigate adolescent exposure to online pornography in an effort to elucidate these relationships. Collectively, these studies suggest that youth who consume pornography may develop unrealistic sexual values and beliefs. Among the findings, higher levels of permissive sexual attitudes, sexual preoccupation, and earlier sexual experimentation have been correlated with more frequent consumption of pornography…. Nevertheless, consistent findings have emerged linking adolescent use of pornography that depicts violence with increased degrees of sexually aggressive behavior. The literature does indicate some correlation between adolescents’ use of pornography and self-concept. Girls report feeling physically inferior to the women they view in pornographic material, while boys fear they may not be as virile or able to perform as the men in these media. Adolescents also report that their use of pornography decreased as their self-confidence and social development increase. Additionally, research suggests that adolescents who use pornography, especially that found on the Internet, have lower degrees of social integration, increases in conduct problems, higher levels of delinquent behavior, higher incidence of depressive symptoms, and decreased emotional bonding with caregivers.

Prause, Ley and Klein have grossly misrepresented the current state of the research for the last few years. Now, they’ve conveniently bundled all the outlying, cherry-picked studies they regularly cite into this article. We expose the truth below. The relevant Prause/Klein/Kohut excerpts listed here are in the same sequence as in the article.

EXCERPT #1: Repeat after me: “Neither the DSM-5 nor the ICD-11 recognizes any addiction, only disorders”

SLATE EXCERPT: “We are also accustomed to the shock when journalists learn that “pornography addiction” is actually not recognized by any national or international diagnostic manual.”

Nice try at fooling the readers, but, again, neither the ICD-11 nor the APA’s DSM-5 ever uses the word “addiction” to describe an addiction – whether it be gambling addiction, heroin addiction, cigarette addiction or you name it. Both diagnostic manuals use the word “disorder” instead of “addiction” (i.e. “gambling disorder” “nicotine use disorder”, and so on). Thus, “sex addiction” and “porn addiction” could never have been rejected, because they were never under formal consideration in the major diagnostic manuals. Put simply, there will never be a “porn addiction” diagnosis, just as there will never be a “meth addiction” diagnosis. Yet individuals with the signs and symptoms of consistent with either a “porn addiction” or a “methamphetamine addiction” can be diagnosed using the ICD-11’s provisions.

The new definition resulted from an intensive, four‐year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country. … Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what’s going on in the brain.

The new definition leaves no doubt that all addictions—whether to alcohol, heroin or sex, say—are fundamentally the same. Dr. Raju Haleja, former president of the Canadian Society for Addiction Medicine and the chair of the ASAM committee that crafted the new definition, told The Fix, “We are looking at addiction as one disease, as opposed to those who see them as separate diseases. Addiction is addiction. It doesn’t matter what cranks your brain in that direction, once it has changed direction, you’re vulnerable to all addiction.” …Sex or gambling or food addiction [are] every bit as medically valid as addiction to alcohol or heroin or crystal meth.

QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviors. Does ASAM really believe that food and sex are addicting?

ANSWER: The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. … This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. … Food and sexual behaviors and gambling behaviors can be associated with the ‘pathological pursuit of rewards’ described in this new definition of addiction.

As for the DSM, the American Psychiatric Association (APA) has so far dragged its feet on including compulsive sexual behaviors in its diagnostic manual. When it last updated the manual in 2013 (DSM-5), it didn’t formally consider “internet porn addiction,” opting instead to debate “hypersexual disorder.” The latter umbrella term for problematic sexual behavior was recommended for inclusion by the DSM-5’s own Sexuality Work Group after years of review. However, in an eleventh-hour “star chamber” session (according to a Work Group member), other DSM-5 officials unilaterally rejected hypersexuality, citing reasons that have been described as illogical.

In reaching this position, the DSM-5 disregarded formal evidence, widespread reports of the signs, symptoms and behaviors consistent with compulsion and addiction from sufferers and their clinicians, and the formal recommendation of thousands of medical and research experts at the American Society of Addiction Medicine.

Incidentally, the DSM has earned distinguished critics who object to its approach of ignoring underlying physiology and medical theory to ground its diagnoses solely in symptoms. The latter permits erratic, political decisions that defy reality. For example, the DSM once incorrectly classified homosexuality as a mental disorder.

Just prior to the DSM-5’s publication in 2013, Thomas Insel, then Director of the National Institute of Mental Health, warned that it was time for the mental health field to stop relying on the DSM. Its “weakness is its lack of validity,” he explained, and “we cannot succeed if we use DSM categories as the “gold standard.” He added, “That is why NIMH will be re-orienting its research away from DSM categories.” In other words, the NIMH would stop funding research based on DSM labels (and their absence).

It will be interesting to see what occurs with the next update of the DSM. (Note: DSM-5 did create a behavioral addiction category)

EXCERPT #2: Crocodile tears

SLATE EXCERPT: Scientists and clinicians who present evidence that challenges these harm-focused narratives—and we count ourselves among that group—face serious social and political opposition to their research. It can be tough for this info to make it to the public too.

These authors spin the yarn that pro-porn advocates “face serious social and political opposition to their research” and that it can be “tough for this info to make it to the public.” Not so. In fact, pro-porn spokespersons are greatly over-represented in the press, and they have done much, often behind the scenes, to suppress opposing evidence of porn’s harms in both the popular and academic literature. (Examples)

Predictably, these authors offer no evidence of their supposed social and political difficulties. A few statistics will serve to reveal the true situation.

A Google search for “Nicole Prause” + pornography returns 16,600 results over relatively few years. Prause’s powerhouse media exposure includes quotations of her pro-porn/anti-porn addiction views in some of the most popular mainstream outlets, including Slate, Daily Beast, The Atlantic, Rolling Stone, CNN, NPR, Vice, The Sunday Times, and countless smaller outlets. Clearly Prause gets what she pays for from her glossy public relations firm. See http://media2x3.com/category/nikky-prause/

Clearly, it is the serious academic researchers who are discriminated against in the press. Consequently, readers are advised to take these pro-porn authors’ narrative about the hardships they face in publicizing their pro-porn views with a healthy degree of skepticism. Journalists should do more responsible, less biased due diligence in this fractious, fractured field.

EXCERPT #3: A blog post by Playboy staff writer is all you got?

SLATE EXCERPT: They are also told that there is an epidemic of erectile dysfunction emerging in young men and that porn is the cause (though actual evidence suggests that there’s not).

Prause/Klein/Kohut attempt unconvincingly to debunk the well documented rise in youthful erectile dysfunction with a blog post by Justin Lehmiller, a regular paid contributor to Playboy Magazine. It shouldn’t surprise anyone that Lehmiller is a close ally of Prause, having featured her in at least ten of his blog posts. ­­­These and many other Lehmiller blogs perpetuate the same false narratives: porn use causes no problems and porn addiction/porn-induced sexual dysfunctions do not exist. Before we address Lehmiller’s sleight of hand regarding porn-induced sexual dysfunction, let’s examine the evidence.

Historical ED rates: Erectile dysfunction was first assessed in 1940s when the Kinsey report concluded that the prevalence of ED was less than 1% in men younger than 30 years, less than 3% in those 30–45. While ED studies on young men are relatively sparse, this 2002 meta-analysis of 6 high-quality ED studies reported that 5 of the 6 reported ED rates for men under 40 of approximately2%. The 6th study reported figures of 7-9%, but the question used could not be compared to the 5 other studies, and did not assess chronic erectile dysfunction: “Did you have trouble maintaining or achieving an erection any time in the last year?” (Yet this anomalous study is the one that Lehmiller irresponsibly uses for comparison.)

At the end of 2006 free, streaming porn tube sites came on line and gained instant popularity. This changed the nature of porn consumption radically. For the first time in history, viewers could escalate with ease during a masturbation session without any wait.

Nine studies since 2010: Nine studies published since 2010 reveal a tremendous rise in erectile dysfunctions. This is documented in this lay article and in this peer-reviewed paper involving 7 US Navy doctors – Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016). In the 9 studies, erectile dysfunction rates for men under 40 ranged from 14% to 37%, while rates for low libido ranged from 16% to 37%. Other than the advent of streaming porn (2006) no variable related to youthful ED has appreciably changed in the last 10-20 years (smoking rates are down, drug use is steady, obesity rates in males 20-40 up only 4% since 1999 – see this study).

Lehmiller’s sleight of hand: Lehmiller carefully selected two mismatched studies, with data separated by 18 years, in an attempt to convince the reader that ED rates have always been around 8% for men under 40:

1) The “way things were study” from 1992 is the one that asked: “Did you have trouble maintaining or achieving an erection any timein the last year?” Rates of yes to this question were between 7-9%.

2) The “modern study” with 2010-12 data that asked whether men had trouble getting or keeping an erection for a period of three or more months during the last year.” This study reported the following rated of sexual functioning problems in 16-21 year old males:

Lacked interest in having sex: 10.5%

Difficulty reaching climax: 8.3%

Difficulty achieving or maintaining an erection: 7.8%

Lehmiller “summarized” these findings for the vision-impaired as he tried to mislead them:

“Although these data were collected in different Western countries and the question wording differed, it’s striking how similar the figures are considering that the data were collected 20 years apart. This suggests that perhaps rates of ED aren’t on the rise among young men after all.”

Sorry Justin, but the questions are not “worded differently”; they are completely different questions. The 1992 study asked whether over the course of the last year at any point you had trouble getting it up. This includes when you were drunk, sick, just wanked three times in a row, experienced performance anxiety, whatever. I’m surprised it’s only 7-9%. In contrast, the 2010 study asked whether you had a persistent problem of erectile dysfunction over a period of three months or more: this was for 16-21 year olds, not men 39 and under!

As one recovery-forum member observed, Justin Lehmiller’s “science analysis” is Buzzfeed level clickbait, not science journalism.

But you may ask: Why are the ED rates about 8% in the 2010-2012 study, yet 14-37% in the 9 other studies published since 2010?

First, 8% isn’t low, as that would translate in a 600%-800% increase for men under 40.

Second, it wasn’t men under 40 – it was 16 to 21 year olds, so virtually none of them should have chronic ED.

Third, unlike the other 9 studies that employed anonymous surveys, this study used face to face in-home interviews. (It’s quite possible that adolescents would be less than fully forthcoming under such circumstances.)

The study gathered its data between August, 2010 and September, 2012. Studies reporting a significant rise in under-25 ED first appeared in 2011. More recent studies on the 25 and under crowd report higher rates (see this 2014 study on Canadian adolescents).

Many of the other studies used the IIEF-5 or IIEF-6, which assess sexual problems on a scale, as opposed to the simple yes or no (in the past 3 months) employed in the Lehmiller’s chosen paper.

Before leaving this topic, it would be well to look at some of the most irrefutable research that demonstrates a radical rise in ED rates over a decade using very large samples (which increase reliability). All the men were assessed using the same (yes/no) question about ED, as part of the Global Study of Sexual Attitudes and Behavior (GSSAB), administered to 13,618 sexually active men in 29 countries. That occurred in 2001-2002.

Based on the findings of prior studies one would predict the older men would have far higher ED scores than the younger men, whose scores should have been negligible. Not so. In just a decade, things had changed radically. The 2001-2002 ED rates for men 40-80 were about 13% in Europe. By 2011, ED rates in Europeans, ages 18-40, ranged from 14-28%!

What changed in men’s sexual environment during this time? Well, major changes were internet penetration and access to porn videos (followed by access to streaming porn in 2006, and then smartphones on which to view it). In the 2011 study on Croatians, Norwegians and Portuguese, the Portuguese had the lowest rates of ED and the Norwegians had the highest. In 2013, internet penetration rates in Portugal were only 67%, compared with 95% in Norway.

However, pornography consumption was associated with lower interpersonal satisfaction outcomes in cross-sectional surveys, longitudinal surveys, and experiments. Associations between pornography consumption and reduced interpersonal satisfaction outcomes were not moderated by their year of release or their publication status.

related to high levels of exposure to and experience with sexually explicit materials.

The men experiencing erectile dysfunction had spent a considerable amount of time in bars and bathhouses where porn was “omnipresent” and “continuously playing.” The researchers stated:

Conversations with the subjects reinforced our idea that in some of them a high exposure to erotica seemed to have resulted in a lower responsivity to “vanilla sex” erotica and an increased need for novelty and variation, in some cases combined with a need for very specific types of stimuli in order to get aroused.

“We assume that subjects with a high porn consumption need increasing stimulation to receive the same amount of reward. That could mean that regular consumption of pornography more or less wears out your reward system. That would fit perfectly the hypothesis that their reward systems need growing stimulation.”

3) Adolescents and web porn: a new era of sexuality (2015) – This Italian study analyzed the effects of internet porn on high school seniors, co-authored by urology professor Carlo Foresta, president of the Italian Society of Reproductive Pathophysiology. The most interesting finding is that 16% of those who consume porn more than once a week report abnormally low sexual desire, as compared with 0% in non-consumers – which is exactly what you would expect for 18-year old men.

EXCERPT #5: Another lesson in how to manipulate data and bury findings

SLATE EXCERPT: Amazingly, the first nationally representative peer-reviewed study on sex-film viewing was only just published in 2017 in Australia. This study found that 84 percent of men and 54 percent of women had ever viewed sexual material. Overall, 3.69 percent of men (144 of 3,923) and 0.65 percent of women (28 of 4,218) in the study believed that they were “addicted” to pornography, and only half of this group reported that using pornography had any negative impact on their lives.

With pro-porn researcher Alan McKee as an author of the study named here it’s not surprising the lead headline was buried away in the study’s tables, while a cleverly worded abstract leaves the reader with the impression that only a small percentage of porn users believe porn is having a bad effects. McKee has a long history of defending porn. He authored “The Porn Report”, which an ABC analysis said was “on an ideological mission to provide an apologia for the sex industry”.

In fact, ABC revealed that: “The project on which the book is based was funded by the Australian Research Council from 2002 to 2004, and was conducted in liaison with, and with support from, the peak Australian sex industry organisation, the Eros Association, along with pornography businesses such as Gallery Entertainment and Axis Entertainment.” (emphasis supplied)

So what key finding was buried in the Australian study? 17% of males and females aged 16-30 reported that using pornography had a bad effect on them. It’s important to note that the data is 6 years old (2012), and the questions are based purely upon self-perception. Keep in mind that addicts rarely see themselves as addicted. In fact, most internet porn users are unlikely to connect symptoms to porn use unless they quit for an extended period. Here’s a screenshot of Table 5 (results):

How different would the headlines from this study have been if the authors had emphasized their key finding that nearly 1 in 5 young people believed that porn use had a “bad effect on them”? Why did they attempt to downplay this finding by ignoring it and focusing on cross-sectional results – rather than the millennial group most at risk for internet problems?

Here are a few additional reasons to take the headlines with a grain of salt:

This was a cross-sectional representative study spanning age groups 16-69, males and females. It’s well established that young men are the primary users of internet porn. So, 25% of the men and 60% of the women had not viewed porn at least once in the last 12 months. Thus the statistics gathered minimize the problem by veiling the at-risk users.

The single question, which asked participants if they had used porn in the last 12 months, doesn’t meaningfully quantify porn use. For example, a person who bumped into a porn site pop-up is grouped with someone who masturbates 3 times a day to hardcore porn.

However, when the survey inquired of those who “had ever viewed porn” which ones had viewed porn in the past year, the highest percentage was the teen group. 93.4% of them had viewed in the last year, with 20-29 year olds just behind them at 88.6.

Data was gathered between October 2012 and November 2013. Things have changed a lot in the last 4 years thanks to smartphone penetration – especially in younger users.

Questions were asked in computer-assisted telephone interviews. It’s human nature to be more forthcoming in completely anonymous interviews, especially when interviews are about sensitive subjects such as porn use and porn-related problems.

The questions are based purely upon self-perception. Keep in mind that addicts rarely see themselves as addicted. In fact, most internet porn users are unlikely to connect their symptoms to porn use unless they first quit for an extended period.

The study did not employ standardized questionnaires (given anonymously), which would more accurately have assessed both porn addiction and porn’s effects on users.

What’s the data from recent studies where all participants intentionally viewed internet porn at least once in the last, say, 3-6 months, or even the last year?

Emotion Regulation and Sex Addiction among College Students (2017): The study utilized the SAST-R “Core Scale” to assess sexual addiction. Among a sample of 337 college students, 57 (16.9 %) scored in the clinical range of sexual addiction. Breaking this down by gender, 17.8% of males and 15.5% of females in the sample surpassed the clinical cutoff.

EXCERPT #6: Study reveals that self-delusion is widespread in Canada

SLATE EXCERPT: Interestingly, even among the minority of users who believe they are “addicted” to pornography, remission may be spontaneous: A study following people over time found that 100 percent of women and 95 percent of men concerned about their frequent sexual behaviors (again, not assessed clinically) no longer felt that they were addicted to sex within five years despite no documented intervention.

First spin: Contrary to the excerpt, the Canadian study did not ask participants if “they believed themselves to be addicted.” Instead, once a year (2006 to 2011) participants were asked “whether their over-involvement in the behavior had caused significant problems for them in the past 12 months”. The six behaviors were: exercise, shopping, online chat, video gaming, eating or sexual behaviors. The Slate excerpt is referring to the percentage of participants who thought they had a significant problem in ALL 5 years.

Second spin: Contrary to the excerpt all the problematic sexual behaviors were lumped together into one category – like the ICD-11 has done with CSBD. There was no “remission from porn addiction” as no participant was asked if they believed themselves to be addicted to pornography.

Third spin: Contrary to the spin, problematic sexual behaviors were the most stable excessive problem, which is remarkable as it is well established that for many libido tends to fall with age. Excerpt from study:

Our data suggested that in the vast majority of cases the reported problem behaviors were transient (Table 3). Within the subsample of respondents reporting a given problem behavior, most participants reported the given excessive behavior only once during the 5-year study period. Even the most stable problem behavior (excessive sexual behavior) was reported five times only by 5.4% of those males who reported having difficulties with this problem behavior.

The study also reveals that far more people actually have a problem than perceive they have a problem: In a clear example of self-delusion only 38 out of the 4,121 participants thought they had a problem with eating (answering ‘yes’ in 4 out of 5 years). In other words, less than 1%of Canadians believe their eating habits are causing them problems or are disordered. How could this be when 30% of adult Canadians are obese, while another 43% are overweight? Let’s not forgot the remaining 27% of Canadians who are not overweight, yet may be dealing with an eating disorder, such as anorexia nervosa or bulimia.

How could more than 99% of Canadians believe their eating habits are of no concern, when the majority of them appear to have a problem? And what does the finding really tell us about this type of study? Maybe it’s not that individuals rarely have problematic behaviors, or that troublesome behaviors fade away. Maybe, it’s exposing what is commonly acknowledged: we humans are really good at lying to ourselves.

In several places Prause/Klein/Kohut utilize various tactics to convince the reader that porn use has no effects of intimate relationships. They must be employing the tried and true political strategy of “attack your opponents strength,” but it won’t work. We will repeatedly cite the current state of the peer-reviewed literature and expose their subterfuge. In this excerpt suggesting that porn isn’t “bad for relationships” they cite only a single article, in Dutch, which is not peer-reviewed.

When evaluating the research, it’s important to know that coupled females who regularly use internet porn (and can thus report on its effects) make up a relatively small percentage of all porn users. Large, nationally representative data are scarce, but the General Social Survey reported that only 2.6% of all US women had visited a “pornographic website” in the last month. The question was only asked in 2002 and 2004 (see Pornography and Marriage, 2014). Sure, porn use by younger women may have increased since 2004. Still, however, studies reporting that more porn use is correlated to greater satisfaction in women are referring to a relatively small percentage of women (perhaps only 1-2% of the female population). For example, below is a graph from one the few studies to report that more porn use is related to greater satisfaction in females.

It’s important to note that “Full” refers to males and females combined. Since the “Full” and “Men” lines are nearly identical, this tells us that almost all the frequent porn users at the far end were males. In other words the women who use 2-3 times a month or more probably comprise only 1-2% of all females. This would align with the 2004 nationally representative study mentioned above where only 2.4% of women had visited a porn site in the last month.

This raises several unanswered questions: What characteristics do the 1%-2% of female porn users have that leads to greater use, yet greater satisfaction? Are they into BDSM or other kinks? Are they in polyamorous relationships? Do these women possess extremely high libidos or have an addiction to porn? Whatever the reason for high levels of porn use in a tiny fraction of women, does this really tell us anything about the effects of regular porn on the other 98-99% of adult women?

The 2 studies did not assess if compulsive porn users had trouble controlling their porn use – as the excerpt falsely implies. Instead, the two studies had subjects watch a bit of porn, instructing them to attempt reduce their sexual arousal. The studies compared subjects’ scores on a sex addiction test with subjects’ ability to control their sexual arousal while watching a short clip of vanilla porn. The results for both studies were all over the place, with no clear cut correlations between the sex addiction test and the ability to inhibit one’s arousal.

The Prause/Klein/Kohut assertion is that subjects scoring highest on the sex addiction test should score lowest on controlling their arousal. Since there was no clear cut correlation in the 2 studies then “porn addiction must not exist.” Here’s why this is nonsense:

1) As stated, the studies did not assess subject’s “ability to control porn use despite negative consequences,” only transient arousal in a lab setting with a bunch of strangers in white coats lurking about.

2) The studies did not assess which participants were or were not “porn addicts” – as the researchers only used “sex addiction” questionnaires. For example, Prause’s study relied upon the CBSOB, which has zero questions about internet porn use. It only asks about “sexual activities,” or if subjects are worried about their activities (e.g., “I am worried I am pregnant,” “I gave someone HIV,” “I experienced financial problems”). Thus any correlations between scores on the CBSOB and ability to regulate arousal are irrelevant for internet porn use.

3)Most importantly: Even though neither study identified which participants were porn addicts, Prause/Klein/Kohut seem to claim that actual “porn addicts” should be the least able to control their sexual arousal while viewing porn. Yet why would they think porn addicts should have “higher arousal’ when Prause et al., 2015 reported that more frequent porn users had less brain activation to vanilla porn than did controls? (Incidentally, another EEG study similarly found that greater porn use in women correlated with less brain activation to porn.) The findings of Prause et al. 2015 align with Kühn & Gallinat (2014), which found that more porn use correlated with less brain activation in response to pictures of vanilla porn, and with Banca et al. 2015, which found faster habituation to sexual images in porn addicts.

It is not uncommon for frequent porn users to develop tolerance, which is the need for greater stimulation in order to achieve the same level of arousal. Vanilla porn can become boring. A similar phenomenon occurs in substance abusers who require bigger “hits” to achieve the same high. With porn users, greater stimulation is often achieved by escalating to new or extreme genres of porn. A recent study found that such escalation is very common in today’s internet porn users. 49% of the men surveyed had viewed porn that “was not previously interesting to them or that they considered disgusting.” In fact, multiple studies have reported findings consistent habituation or escalation in frequent porn users – an effect entirely consistent with the addiction model.

Key point: The authors’ entire claim rests upon the unsupported prediction that “porn addicts” should experience greater sexual arousal to static images of vanilla porn, and thus less ability to control their arousal. Yet the prediction that compulsive porn users would experience greater arousal to vanilla porn and greater sexual desire has repeatedly been refuted by several lines of research:

A single paper, co-authored by Nicole Prause, was cited to support the claim that porn use has no effects on sexual functioning (“…..nor with their erectile functioning.“) Before we address this heavily criticized paper (Prause & Pfaus), let’s review the evidence in support of porn-induced sexual dysfunctions.

Prause & Pfaus 2015 wasn’t a study on men with ED. It wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. It’s disturbing that this paper by Nicole Prause and Jim Pfaus passed peer-review as the data in their paper did not match the data in the underlying four studies on which the paper claimed to be based. The discrepancies are not minor gaps, but gaping holes that cannot be plugged. In addition, the paper made several claims that were false or not supported by their data.

We begin with false claims made by both Nicole Prause and Jim Pfaus. Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Nicole Prause and Jim Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In the Jim Pfaus TV interview Pfaus states:

We looked at the correlation of their ability to get an erection in the lab.

We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.

In this radio interview Nicole Prause claimed that erections were measured in the lab. The exact quote from the show:

The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s not clear from the underlying papers that this simple self-report was even asked of all subjects). In any case, an excerpt from the paper itself admitted that:

No physiological genital response data were included to support men’s self-reported experience”

In other words, no actual erections were tested or measured in the lab, which means that no such data or conclusions were peer-reviewed!

In a second unsupported claim, lead author Nicole Prause tweeted several times about the study, letting the world know that 280 subjects were involved, and that they had “no problems at home.” However, the four underlying studies contained only 234 male subjects, so “280” is way off.

A third unsupported claim: Dr. Isenberg’s Letter to the Editor (linked to above), which raised multiple substantive concerns highlighting the flaws in Prause & Pfaus , wondered how it could be possible for Prause & Pfaus to have compared different subjects’ arousal levels when three different types of sexual stimuli were used in the 4 underlying studies. Two studies used a 3-minute film, one study used a 20-second film, and one study used still images. It’s well established that films are far more arousing than photos, so no legitimate research team would group these subjects together to make claims about their responses. What’s shocking is that in their paper authors Prause and Pfaus unaccountably claim that all 4 studies used sexual films:

“The VSS presented in the studies were all films.”

This statement is false, as clearly revealed in Prause’s own underlying studies. This is the first reason why Prause and Pfaus cannot claim that their paper assessed “arousal.” You must use the same stimulus for each subject to compare all subjects.

A fourth unsupported claim: Dr. Isenberg also asked how Prause & Pfaus 2015 could compare different subjects’ arousal levels when only 1 of the 4 underlying studies used a 1 to 9 scale. One used a 0 to 7 scale, one used a 1 to 7 scale, and one study did not report sexual arousal ratings. Once again Prause and Pfaus inexplicably claim that:

“Men were asked to indicate their level of “sexual arousal” ranging from 1 “not at all” to 9 “extremely.”

This statement, too, is false, as the underlying papers show. This is the second reason why Prause and Pfaus cannot claim that their paper assessed “arousal” ratings in men. A study must use the same rating scale for each subject to compare the subjects’ results. In summary, all the Prause-generated headlines and claims about porn use improving erections or arousal, or anything else, are unsupported by her research.

Authors Prause and Pfaus also claimed they found no relationship between erectile functioning scores and the amount of porn viewed in the last month. As Dr. Isenberg pointed out:

Even more disturbing is the total omission of statistical findings for the erectile function outcome measure. No statistical results whatsoever are provided. Instead the authors ask the reader to simply believe their unsubstantiated statement that there was no association between hours of pornography viewed and erectile function. Given the authors’ conflicting assertion that erectile function with a partner may actually be improved by viewing pornography the absence of statistical analysis is most egregious.

As is customary when a letter critical of a study is published, the study’s authors were given a chance to respond. Prause’s pretentious response entitled “Red Herring: Hook, Line, and Stinker” not only evades Isenberg’s points (and Gabe Deem’s), it contains several new misrepresentations and several transparently false statements. In fact, Prause’s reply is little more than smoke, mirrors, groundless insults, and falsehoods. This extensive critique by Gabe Deem exposes the Prause and Pfaus response for what it is: A critique of the Prause & Pfaus response to Richard Isenberg’s letter.

Summary: The 2 core claims made by Klein/Kohut/Prause remain unsupported:

Prause & Pfaus failed to provide data for its core claim that porn use was not related to scores on an erection questionnaire (IIEF).

Prause & Pfaus failed to explain how its authors could reliably assess “arousal” when the 4 underlying studies used different stimuli (still images vs. films), and use no scale or very different number scales (1-7, 1-9, 0-7, no scale).

If Prause and Pfaus had answers to the above concerns, they would have put them in their response to Dr. Isenberg. They didn’t.

EXCERPT #9: When confronted with hundreds of studies linking porn use to negative outcomes just shout “correlation is not causation”

SLATE EXCERPT: However, a core problem with this area of research is that the overwhelming majority of studies are cross-sectional, meaning they just ask about your life as it is now. This means that they cannot show causality. Remember the old “correlation is not causation” principle from science class? If your marriage is not going well or you stopped being intimate years ago, chances are good that someone in that relationship is masturbating to sate their unfulfilled sexual desire.

Translation: “You are getting very, very sleepy…your eyelids are getting heavy… no matter what 58 studies on porn use relationships reveal, it’s really masturbation…. You are now asleep.… it can’t be porn….porn is good for you…. it must be masturbation…. Go deeper asleep, deeper asleep.”

On to the “correlation doesn’t equal causation” mantra that any 7th grader can recite. When confronted with hundreds of studies linking porn use to negative outcomes, a common tactic by pro-porn PhDs is to claim that “no causation has been demonstrated.” The reality is that when it comes to psychological and medical studies, very little research reveals causationdirectly. For example, all studies on the relationship between lung cancer and cigarette smoking in humans are correlative. Yet cause and effect are now clear to everyone but the tobacco lobby.

For ethical reasons, researchers are usually precluded from constructing experimental research designs that would reveal definitively whether pornography causes certain harms. Therefore, they use correlational models. Over time, when a significant body of correlational studies is amassed in any given research area, there comes a point where the body of evidence can be said to demonstrate a point of theory, despite a lack of the ideal, but often unethical to conduct, experimental studies.

Put another way, no single correlation study may ever provide a “smoking gun” in an area of study, but the converging evidence of multiple correlational studies can establish cause and effect. When it comes to porn use, nearly every study published is correlative.

To “prove” that porn use is causing erectile dysfunction, relationship problems, emotional problems or addiction-related brain changes you would have to have two large groups of identical twins separated at birth. Make sure one group never watches porn. Make sure that every individual in the other group watches the exact same type of porn, for the exact same hours, at the exact same age. And continue the experiment for 30 years or so, followed by assessment of the differences.

Alternatively, research attempting to demonstrate causation could be done using the following 3 methods:

Eliminate the variable whose effects you wish to measure. Specifically, have porn users stop, and assess any changes weeks, months (years?) later. This is exactly what is occurring as thousands of young men stop porn as a way to alleviate chronic non-organic erectile dysfunction and other symptoms (caused by porn use).

Perform longitudinal studies, which means following subjects over a period of time to see how changes in porn use (or levels of porn use) relate to various outcomes. For example, correlate levels of porn use with rates of divorce over years (asking other questions to control for other possible variables).

Expose willing participants to pornography and measure various outcomes. For example, assess subjects’ ability to delay gratification both before and after exposure to porn in a lab setting.

Below we list studies that have employed these 3 methods: elimination porn use, longitudinal studies, exposure to pornography in a lab. All of the results strongly suggest that porn use leads to negative outcomes.

Section #1: Studies where participants eliminated porn use:

The first 5 studies in this section demonstrate porn use causing sexual problems as participants eliminated porn use and healed chronic sexual dysfunctions. Thus, the debate about whether porn-induced sexual dysfunctions exist has been settled for some time now.

1) Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016): An extensive review of the literature related to porn-induced sexual problems. Co-authored by 7 US Navy doctors (urologists, psychiatrists, and an MD with PhD in neuroscience), the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via internet porn. The authors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use.

2) Male masturbation habits and sexual dysfunctions (2016): Authored by a French psychiatrist and president of the European Federation of Sexology. The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches for helping them. The author states that most of his patients used porn, with a quarter of them being addicted to porn. The abstract points to internet porn as the primary cause of patients’ problems. 19 of the 35 men saw significant improvements in sexual functioning. The other men either dropped out of treatment or were still trying to recover.

4) How difficult is it to treat delayed ejaculation within a short-term psychosexual model? A case study comparison (2017): This is a report on two “composite cases” illustrating the etiology and treatments for delayed ejaculation (anorgasmia). “Patient B” represented multiple young men treated by the therapist. Patient B’s “porn use had escalated into harder material,” “as is often the case.” The paper says that porn-related delayed ejaculation is not uncommon, and on the rise. The author calls for more research on porn’s effects on sexual functioning. Patient B’s delayed ejaculation was healed after 10 weeks of no porn.

5) Situational Psychogenic Anejaculation: A Case Study (2014): The details reveal a case of porn-induced anejaculation. The husband’s only sexual experience prior to marriage was frequent masturbation to pornography (where he was able to ejaculate). He also reported sexual intercourse as less arousing than masturbation to porn. The key piece of information is that “re-training” and psychotherapy failed to heal his anejaculation. When those interventions failed, therapists suggested a complete ban on masturbation to porn. Eventually this ban resulted in successful sexual intercourse and ejaculation with a partner for the first time in his life.

3) Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2016). Excerpt: This study is the first to draw on nationally representative, longitudinal data (2006-2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography’s effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012.

4) Till Porn Do Us Part? Longitudinal Effects of Pornography Use on Divorce, (2016). The study used nationally representative General Social Survey panel data collected from thousands of American adults. Excerpt: Beginning pornography use between survey waves nearly doubled one’s likelihood of being divorced by the next survey period, from 6 percent to 11 percent, and nearly tripled it for women, from 6 percent to 16 percent. Our results suggest that viewing pornography, under certain social conditions, may have negative effects on marital stability.

6) Pornography Use and Marital Separation: Evidence from Two-Wave Panel Data (2017). Excerpt: analyses showed that married Americans who viewed pornography at all in 2006 were more than twice as likely as those who did not view pornography to experience a separation by 2012, even after controlling for 2006 marital happiness and sexual satisfaction as well as relevant sociodemographic correlates. The relationship between pornography use frequency and marital separation, however, was technically curvilinear.

7) Are Pornography Users More Likely to Experience A Romantic Breakup? Evidence from Longitudinal Data (2017). Excerpt: analyses demonstrated that Americans who viewed pornography at all in 2006 were nearly twice as likely as those who never viewed pornography to report experiencing a romantic breakup by 2012, even after controlling for relevant factors such as 2006 relationship status and other sociodemographic correlates. Analyses also showed a linear relationship between how frequently Americans viewed pornography in 2006 and their odds of experiencing a breakup by 2012.

2) Effects of Prolonged Consumption of Pornography on Family Values (1988). Excerpt: Exposure prompted, among other things, greater acceptance of pre- and extramarital sex and greater tolerance of nonexclusive sexual access to intimate partners. Exposure lowered the evaluation of marriage, making this institution appear less significant and less viable in the future. Exposure also reduced the desire to have children and promoted the acceptance of male dominance and female servitude. With few exceptions, these effects were uniform for male and female respondents as well as for students and nonstudents.

3) Pornography’s Impact on Sexual Satisfaction (1988). Excerpt: Male and female students and nonstudents were exposed to videotapes featuring common, nonviolent pornography or innocuous content. Exposure was in hourly sessions in six consecutive weeks. In the seventh week, subjects participated in an ostensibly unrelated study on societal institutions and personal gratifications. [Porn use] strongly impacted self-assessment of sexual experience. After consumption of pornography, subjects reported less satisfaction with their intimate partners—specifically, with these partners’ affection, physical appearance, sexual curiosity, and sexual performance proper. In addition, subjects assigned increased importance to sex without emotional involvement. These effects were uniform across gender and populations.

4) Influence of popular erotica on judgments of strangers and mates (1989). Excerpt: In Experiment 2, male and female subjects were exposed to opposite sex erotica. In the second study, there was an interaction of subject sex with stimulus condition upon sexual attraction ratings. Decremental effects of centerfold exposure were found only for male subjects exposed to female nudes. Males who found the Playboy-type centerfolds more pleasant rated themselves as less in love with their wives.

6) Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (2013): Study found that viewing pornographic imagery interfered with decision making during a standardized cognitive test. This suggests porn might affect executive functioning, which is a set of mental skills that help you get things done. These skills are controlled by an area of the brain called the prefrontal cortex.

EXCERPT #10: Prause/Klein/Kohut cherry-pick 5% of subjects from 1 of the 58 studies linking porn use to poorer relationships

SLATE EXCERPT: Longitudinal studies following people over time at least show if sex-film viewing occurred before a proposed effect, which is necessary to suggest that sex films caused the effect. For example, one longitudinal study showed that, on average, sex-film viewing increased the risk of relationship loss later. Till Porn Do Us Part? A Longitudinal Examination of Pornography Use and Divorce. However, another study found that married Americans with the highest frequencies of sex-film use actually were at the lowest risk for losing their relationship (a nonlinear effect).

The tactic here is to fool the reader into thinking that the research investigating porn’s effects on relationships is conflicted. They do this by acknowledge the existence of one study linking porn to relationship troubles (out of the 58 studies linking porn use to poorer relationship), followed by cherry-picking the only study reporting an outlier result – for a small percentage of its subjects (5% of subjects).

Drawing on data from the 2006 and 2012 waves of the nationally representative Portraits of American Life Study, this article examined whether married Americans who viewed pornography in 2006, either at all or in greater frequencies, were more likely to experience a marital separation by 2012. Binary logistic regression analyses showed that married Americans who viewed pornography at all in 2006 were more than twice as likely as those who did not view pornography to experience a separation by 2012, even after controlling for 2006 marital happiness and sexual satisfaction as well as relevant sociodemographic correlates. The relationship between pornography use frequency and marital separation, however, was technically curvilinear. The likelihood of marital separation by 2012 increased with 2006 pornography use to a point and then declined at the highest frequencies of pornography use.

The actual results. Grouped together, the pornography users (either the men or the women) were more than twice as likely to experience a marital separation 6 years later. Specifically, for 95% of the subjects, porn use in 2006 was related with an increased likelihood of marital separation in 2012. However, once porn use frequency reached several times a week or more (only 5% of subjects) the likelihood of separation was about the same as for those who didn’t use porn.

As pointed out under excerpt #7 correlations at the far end of the bell curve may not predict results for the vast majority of porn users. In this mixed bag of 2-5% of frequent users we may find a much higher percentage of couples who identify as swingers or polyamorous. They may have open marriages. Maybe the couple has an understanding that the partner can use as much porn as desired, but divorce is never an option. Whatever the reason for high levels of porn use in one or both partners, it’s clear from this study and all the rest, that the outliers don’t line up with the vast majority of couples.

By the way, all the other longitudinal studies confirm that porn use is related poorer relationship outcomes.

Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2016). Excerpt: This study is the first to draw on nationally representative, longitudinal data (2006-2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography’s effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012.

Are Pornography Users More Likely to Experience A Romantic Breakup? Evidence from Longitudinal Data (2017). Excerpt: analyses demonstrated that Americans who viewed pornography at all in 2006 were nearly twice as likely as those who never viewed pornography to report experiencing a romantic breakup by 2012, even after controlling for relevant factors such as 2006 relationship status and other sociodemographic correlates. Analyses also showed a linear relationship between how frequently Americans viewed pornography in 2006 and their odds of experiencing a breakup by 2012.

How the study linked to supports this talking point is anyone’s guess. Perhaps they think the reader will misread this as “porn viewing leads to greater desire for sex with a real person that is sustained for several months.” But that’s not what the study reported.

This was a study about mechanisms behind compulsive behaviors (overeating and compulsive sexual behaviors). The study found that greater cue-reactivity to porn correlated with greater cravings to have sex and masturbate six months later. The study did not assess “desire to be with a partner.” It only assessed cravings to masturbate and have sex, which wasn’t limited to a single partner. The study found similar results for food: subjects with greater cue-reactivity to images of enticing food gained the most weight over the next six months. From the study’s abstract:

These findings suggest that heightened reward responsivity in the brain to food and sexual cues is associated with indulgence in overeating and sexual activity, respectively, and provide evidence for a common neural mechanism associated with appetitive behaviors.

This study supports the addiction model, as subjects with the greatest cue-reactivity (reward center activity) in response to porn experienced greater cravings to act out six months later. It appears these individuals had become sensitized to pornography, which manifested as both cue-reactivity and cravings to use. Addiction researchers view sensitizationas the core brain change that leads to compulsive consumption and ultimately addiction. (See “The incentive sensitization theory of addiction”)

It’s important to note that sensitization is not a sign of true libido or desire to get close to a partner. Instead, it’s evidence of hyper-sensitivity to memories or cues related to the behavior. For example, cues – such as turning on the computer, seeing a pop-up, or being alone – may trigger intense, hard to ignore cravings to view porn. Studies reveal that compulsive porn users can have greater cue-reactivity or cravings for porn, and yet experience low sexual desire and erectile dysfunction with real partners. For example, in the Cambridge University brain scan studies on porn addicts the subjects had greater brain activation to porn, but many reported arousal/erectile problems with partners. From the 2014 Cambridge study:

[Compulsive sexual behaviour] subjects reported that as a result of excessive use of sexually explicit materials…..they experienced diminished libido or erectile function specifically in physical relationships with women (although not in relationship to the sexually explicit material).

“My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice. How could she draw a conclusion that is the opposite of the actual results?”

In line with the Cambridge University brain scan studies, Steele et al. 2013 also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put it another way, individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesperson Prause claimed that porn users merely had “high libido,” yet the results of the study say the exact opposite (subjects’ desire for partnered sex dropped in relation to their porn use). Five peer-reviewed papers explain the truth: 1, 2, 3,4, 5, 6. Also see this extensive YBOP critique.

In summary, a frequent porn user can experience higher subjective arousal (cravings) yet also experience erection problems with a partner. Arousal in response to porn is not evidence of “sexual responsiveness” or healthy erectile function with a partner.

EXCERPT #12: Even David Ley thinks your citation is questionable

SLATE EXCERPT: Experimental studies can demonstrate if porn viewing really causes negative relationship effects by including controls. The first large, preregistered experiment found that viewing sexual pictures did not diminish love or desire for the current romantic partner.

First, it’s absurd to claim that “Experimental studies can demonstrate if porn viewing really causes negative relationship effects.” Experiments where college-aged guys view a few Playboy centerfolds (as in the study linked to by the authors) can tell you nothing about the effects of your husband masturbating to hard-core videos clips day after day for years on end. The only relationship studies that can “demonstrate if porn viewing really causes negative relationship effects” are longitudinal studies that control for variables or studies where subjects abstain from porn. To date seven longitudinal relationship studies have been published that reveal the real-life consequences of ongoing porn use. All reported that porn use relates to poorer relationship/sexual outcomes:

The 2017 study attempted to replicate a 1989 study that exposed men and women in committed relationships to erotic images of the opposite sex. The 1989 study found that men who were exposed to the nude Playboy centerfolds rated their partners as less attractive and reported less love for their partner. As the 2017 failed to replicate the 1989 findings, we are told that the 1989 study got it wrong, and that porn use cannot diminish love or desire. Whoa! Not so fast.

The replication “failed” because our cultural environment has become “pornified.” The 2017 researchers didn’t recruit 1989 college students who grew up watching MTV after school. Instead their subjects grew up surfing PornHub for gang bang and orgy video clips.

In 1989 how many college students had seen an X-rated video? Not too many. How many 1989 college students spent every masturbation session, from puberty on, masturbating to multiple hard-core clips in one session? None. The reason for the 2017 results is evident: brief exposure to a still image of a Playboy centerfold is a big yawn compared to what college men in 2017 have been watching for years. Even the authors admitted the generational differences with their first caveat:

1) First, it is important to point out that the original study was published in 1989. At the time, exposure to sexual content may not have been as available, whereas today, exposure to nude images is relatively more pervasive, and thus being exposed to a nude centerfold may not be enough to elicit the contrast effect originally reported. Therefore, the results for the current replication studies may differ from the original study due to differences in exposure, access, and even acceptance of erotica then versus now.

In a rare instance of unbiased prose even David Ley felt compelled to point out the obvious:

It may be that the culture, men, and sexuality have substantially changed since 1989. Few adult men these days haven’t seen pornography or nude women—nudity and graphic sexuality are common in popular media, from Game of Thrones to perfume advertisements, and in many states, women are permitted to go topless. So it’s possible that men in the more recent study have learned to integrate the nudity and sexuality they see in porn and everyday media in a manner which doesn’t affect their attraction or love for their partners. Perhaps the men in the 1989 study had been less exposed to sexuality, nudity, and pornography.

Keep in mind that this experiment doesn’t mean internet porn use hasn’t affected men’s attraction for their lovers. It just means that looking at “centerfolds” has no immediate impact these days. Many men report radical increases in attraction to partners after giving up internet porn. And, of course, there is also the longitudinal evidence cited above demonstrating the deleterious effects of porn viewing on relationships.

Once again, Prause/Klein/Kohut provide a dubious, cherry-picked result in a feeble attempt to counter the preponderance of studies reporting porn use linked to divorce, breakups, and poorer sexual and relationship satisfaction.

Finally, it’s important to note that the authors of the paper linked to are colleagues of Taylor Kohut at the University of Western Ontario. This group of researchers, headed by William Fisher, has been publishing questionable studies, which consistently produce results that on the surface appear to counter the vast literature linking porn use to myriad negative outcomes. Moreover, both Kohut and Fisher played big roles in the defeat of Motion 47 in Canada.

Here are two recent studies from Kohut, Fisher and colleagues at Western Ontario that garnered widespread and misleading headlines:

In their 2017 study, Kohut, Fisher and Campbell appear to have skewed the sample to produce the results they were seeking. Whereas most studies show that a tiny minority of porn users’ female partners use porn, in this study 95% of the women used porn on their own (85% of the women had used porn since the beginning of the relationship). Those rates are higher than in college-aged men, and far higher than in any other porn study! In other words, the researchers appear to have skewed their sample to produce the results they were seeking. Reality: Cross-sectional data from the largest US survey (General Social Survey) reported that only 2.6% of women had visited a “pornographic website” in the last month.

In addition, Kohut’s study asked only “open ended” questions where subjects could ramble on about porn. The researchers read the ramblings and decided, after the fact, what answers were “important” (fit their desired narrative?). In other words, the study did not correlate porn use with any objective, scientific variable assessment of sexual or relationship satisfaction (as did the nearly 60 studies that show porn use in linked to negative effects on relationships). Everything reported in the paper was included (or excluded) at the unchallenged discretion of the authors.

Taylor Kohut co-authors framed egalitarianismas: Support for (1) Abortion, (2) Feminist identification, (3) Women holding positions of power, (4) Belief that family life suffers when the woman has a full-time job, and oddly enough (5) Holding more negative attitudes toward the traditional family. Secular populations, which tend to be more liberal, have far higher rates of porn use than religious populations. By choosing these criteria and ignoring endless other variables, lead author Kohut and his co-authors knew they would end up with porn users scoring higher on this study’s carefully chosen selection of what constitutes “egalitarianism.” Then the authors chose a title that spun it all. In reality, these findings are contradicted by nearly every other published study. (See this list of over 25 studies linking porn use to sexist attitudes, objectification and less egalitarianism.)

Note: This 2018 presentation exposes the truth behind 5 questionable and misleading studies, including the two studies just discussed: Porn Research: Fact or Fiction?

EXCERPT #13: Watching porn makes you horny and drinking improves your mood, so there can be no downside to either

Another Nicole Prause paper. Viewing porn, becoming horny, and then wanting to get off, is hardly a remarkable finding. This “laboratory finding” tells us nothing about the long-term effects of porn use on relationships (again, almost 60 studies – and every study on men – link porn use to less sexual and relationship satisfaction). This experiment is akin to evaluating the effects of alcohol by asking bar patrons if they feel good after their first couple of beers. Does this onetime assessment tell us anything about their mood the next morning or the long-term effects of chronic alcohol use?

Not surprisingly, Dr. Prause omitted the rest of her study’s findings:

EXCERPT #14: In order to protect porn, let’s blame masturbation for all the negative effects linked to porn

SLATE EXCERPT: While one study reported that reducing pornography consumption increased commitment to a partner, no study has yet shown that this was due to the sex films themselves and not some other confounding variable, such as differences in masturbation that resulted from adjusting viewing habits. In our view, there are not yet compelling data to confirm that sexual arousal via sex films always decreases desire for the regular sex partner; certainly, under some conditions, sex films appear to stoke the fire at home.

Actually, the vast preponderance of the evidence demonstrates convincingly that as pornography consumption increases, relationship and sexual satisfaction decline. This isn’t a case of some studies “say yes” and some studies “say no”, as every study on males and porn use (55 studies) links greater porn use to decreased sexual or relationship satisfaction. In fact, a recent study pointed out that for men, porn use that was more frequent than once per month correlated with reduced sexual satisfaction. (For women, the cut off was even lower. Use that was more frequent than “several times per year” was associated with reduced sexual satisfaction.)

Also, the porn-commitment study cited above actually did show that viewing porn was the most likely cause of reduced commitment in those who viewed more porn. It is one of the few studies to ask people to (attempt to) eliminate porn use (for 3 weeks) to compare the effects with a control group. Incidentally some of the same researchers published another study comparing delayed discounting in those who temporarily tried to quit porn as well. They found that the more porn participants viewed the less able they were to defer gratification. The

It’s ironic that sexologists like Klein, Prause and Kohut are so bent on defending porn use that they’re willing to imply that masturbation causes relationship problems! (Prause and colleague Ley have also claimed masturbation causes chronic ED in young men – without a shred of medical or other evidence)

Yet at the same time Prause has long insisted publicly that masturbation is an unqualified benefit. So, which is it? Here these authors point the finger at masturbation as the cause of relationship problems, but they offer no formal evidence supporting their hunch. It seems their claim that “it’s masturbation” is only a convenient red herring whenever actual scientific evidence demonstrates that more porn use correlates problems.

Take the example of pornography. Thinking about ways to gain access to it, or actively searching for it, and perhaps experiencing desire during the process, is considered sexual wanting. Watching selected pornographic material, even without masturbation, can be considered “having sex” when there is genital arousal.

Humanity urgently needs researchers who will use sound science (and neuroscience) to investigate human sexuality and the effects of today’s unique sexual environment. Not propagandists serving up red herrings.

SLATE EXCERPT: Speaking to the heart of the issue, one of the biggest problems for some porn users is shame. Shame about viewing sex films is heaped on the public by the sex-addiction treatment industry (for profit), by the media (for clickbait), and by religious groups (to regulate sexuality). Unfortunately, whether you believe porn viewing is appropriate or not, stigmatizing sex-film viewing may be contributing to the problem. In fact, anincreasing number of studiesshow that many people who identify as “porn addicted” do not actually view sex films more than other people. They simply feel more shame about their behaviors, which is associated with growing up in a religious or sexually restrictive society.

The response to excerpt #15 has been combined with the response to excerpt #19 below, as both deal with a single pornography questionnaire (CPUI-9) and the mythology surrounding it and the studies that employ it.

Note: The core claim in the above excerpt is false as there is only one study that directly correlated self-identification as a porn addict with hours of use, religiousness and moral disapproval of porn use. Its findings contradict the carefully constructed narrative about “perceived addiction” (that “porn addiction is just religious shame/moral disapproval”) – which is grounded in studies employing the flawed instrument called the CPUI-9. In the only direct-correlation study, the strongest correlation with self-perception as an addict was with hours of porn use. Religiousness was irrelevant, and while there was predictably some correlation between self-perception as an addict and moral incongruence regarding porn use, it was roughly half the hours-of-use correlation.

EXCERPT #16: Compulsivity is not synonymous with the “Compulsive Sexual Behavior Disorder” diagnosis in the ICD-11

SLATE EXCERPT: It is very important to note that compulsivity is not an umbrella term that includes addiction. Addiction, compulsivity, and impulsivity are all different models with different patterns of response that require different treatments. For example, addiction models predict withdrawal symptoms, but compulsivity models do not predict withdrawal. Impulsivity models predict a strong aversion to delaying decisions or delaying expected pleasure, whereas compulsivity models predict rigid, methodical perseverance.

Once again Prause/Klein/Kohut attempt a clever sleight of hand. They want you to believe that “compulsivity” is synonymous with the Compulsive Sexual Behavior Disorder diagnosis, and that therefore the ICD-11 intended to prevent healthcare givers from using it to diagnose those with porn and sex addiction. However, these terms are not synonymous, which means we could disregard excerpt #17 and its muddled attempts to confuse the reader.

Yet we want to unpack this excerpt further because addiction-deniers like Prause/Klein/Kohut and their colleagues seem to have a bit of a compulsion themselves. They insist on relabeling problematic porn use as a “compulsion” – thus implying that it can never be an “addiction.”

RE: “compulsivity is not an umbrella term that includes addiction.” Depends on whom you ask, but such a question is irrelevant to the ICD-11 Compulsive Sexual Behavior Disorder diagnosis. The use of “Compulsive” in the new ICD-11 diagnosis isn’t meant to denote the neurological underpinnings of CSBD: “continued repetitive sexual behaviour despite adverse consequences.” Instead “Compulsive,” as used in the ICD-11, is a descriptive term that’s been in use for years, and is often employed interchangeably with “addiction.” (For example a Google scholar search for compulsion + addiction returns 130,000 citations.)

Excerpt #17 preys on general ignorance of a well established fact: The ICD and DSM systems are descriptive, largely atheoretical classification systems. They rely on the presence or absence of specific signs and symptoms to establish diagnoses. In other words, the ICD and DSM stay away from endorsing any particular biological theory underlying a mental disorder, whether for depression, schizophrenia, alcoholism, or CSBD.

Incidentally, as the press release of the Society for the Advancement of Sexual Health explained, the Compulsive Sexual Behavior Disorder is under “impulse control disorders” for now but that may change as it did for Gambling Disorder.

For now, the parent category of the new CSBD diagnosis is Impulse Control Disorders, which includes diagnoses such as Pyromania [6C70], Kleptomania [6C71] and Intermittent Explosive Disorder [6C73]. Yet doubts remain about the ideal category. As Yale neuroscientist Marc Potenza MD PhD and Mateusz Gola PhD, researcher at the Polish Academy of Sciences and the University of California San Diego point out, “The current proposal of classifying CSB disorder as an impulse-control disorder is controversial as alternate models have been proposed …There are data suggesting that CSB shares many features with addictions.” 7

It might be worth noting that ICD-11 includes diagnoses of Gambling Disorder under both Disorders Due to Addictive Behaviors and under Impulse Control Disorders. Thus, categorization of disorders need not always be mutually exclusive.5 Classification may also shift with time. Gambling Disorder was originally classified as an impulse disorder in both the DSM-IV and the ICD-10, but based on advances in empirical understanding, Gambling Disorder has been reclassified as a “Substance-Related and Addictive Disorder” (DSM-5) and a “Disorder Due to Addictive Behaviour” (ICD-11). It is possible that this new CSBD diagnosis may follow a similar developmental course as Gambling Disorder has.

While CSBD looks like an addiction and quacks like an addiction, it starts out in the “Impulse Control Disorders” for political reasons. Politics aside, neuroscientists who publish brain studies on CSB subjects strongly believe its rightful home is with other addictions. From the Lancet commentary, Is excessive sexual behaviour an addictive disorder? (2017):

Compulsive sexual behaviour disorder seems to fit well with non-substance addictive disorders proposed for ICD-11, consistent with the narrower term of sex addiction currently proposed for compulsive sexual behaviour disorder on the ICD-11 draft website. We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.

By the way, even if “Compulsive Sexual Behaviour Disorder” is eventually moved to the “Disorder Due to Addictive Behaviour” section it will still likely be called “Compulsive Sexual Behaviour Disorder.” Again, “compulsivity” is not synonymous with the diagnosis of CSBD.

First, the link goes to a confused paper that proposes a theoretical “sex addiction” model that just happens to mirror normal sexual patterns of feeling horny, doing the deed, and not feeling longer horny. The model:

Specifically, the sexhavior cycle suggests that the cycle of sexual behavior comprises four distinct and sequential stages described as sexual urge, sexual behavior, sexual satiation, and post-sexual satiation.

Impulsivity: Acting quickly and without adequate thought or planning in response to internal or external stimuli. A predisposition to accept smaller immediate rewards over larger delayed gratification and an inability to stop a behavior toward gratification once it’s set in motion.

Compulsivity: Refers to repetitive behaviors that are performed according to certain rules or in a stereotypical fashion. These behaviors persevere even in the face of adverse consequences.

Third, the concern about different treatment requirements for each model is a red herring as the ICD-11 doesn’t endorse any particular treatment for CSBD or any other mental or physical disorder. That’s up to the healthcare practitioner. In his 2018 paper, “Compulsive sexual behavior: A nonjudgmental approach, CSBD workgroup member Jon Grant (the same expert whom Prause/Klein/Kohut misrepresented earlier) covered misdiagnosis, differential diagnosis, co-morbidities and various treatments options related to the new CSBD diagnosis. Incidentally, Grant says that Compulsive Sexual Behavior is also called “sex addiction” in that paper!

“It’s not an addiction, it’s a compulsion.” This brings us to the ‘compulsion’ versus ‘addiction’ discussion. Addiction and compulsion are both terms that have entered our everyday language. Like many words that are in common use, they may be misused and misunderstood.

In arguing against the concept of behavioral addictions, especially porn addiction, skeptics often claim that pornography addiction is a ‘compulsion’ and not a true ‘addiction’. Some even insist that addiction is “like” Obsessive-Compulsive Disorder (OCD). When further pressed as to how a ‘compulsion to use X’ differs neurologically from an ‘addiction to X’, a common comeback by these uninformed skeptics is that “behavioral addictions are simply a form of OCD.” Not true.

Obsessive-compulsive spectrum disorders have been considered to conceptualize sexual compulsivity (40) because some studies have found individuals with hypersexual behavior are on the obsessive-compulsive disorder (OCD) spectrum. OCD for hypersexual behavior is not consistent with DSM-5 (1) diagnostic understandings of OCD, which exclude from the diagnosis those behaviors from which individuals derive pleasure. Although obsessive thoughts of the OCD type often have sexual content, the associated compulsions performed in response to the obsessions are not carried out for pleasure. Individuals with OCD report feelings of anxiety and disgust rather than sexual desire or arousal when confronted with situations triggering obsessions and compulsions, with the latter being performed only to quell uneasiness the obsessive thoughts arouse. (41)

Few studies have examined associations between compulsivity and hypersexuality. Among males with nonparaphilic hypersexual disorder [CSBD], the lifetime prevalence of obsessive-compulsive disorder—a psychiatric disorder characterized by compulsivity—ranges from 0% to 14%

Obsessiveness—which may be associated with compulsive behavior—in treatment-seeking men with hypersexuality has been found to be elevated relative to a comparison group, but the effect size of this difference was weak. When the association between the level of obsessive-compulsive behavior—assessed by a subscale of the Structured Clinical Interview for DSM-IV (SCID-II) —and the level of hypersexuality was examined among treatment-seeking males with hypersexual disorder, a trend toward a positive, weak association was found. On the basis of the aforementioned results, compulsivity appears to contribute in a relatively small manner to hypersexuality [CSBD].

In one study, general compulsivity was examined in relation to problematic pornography use among men, showing positive but weak associations. When investigated in a more complex model, the relationship between general compulsivity and problematic pornography use was mediated by sexual addiction and Internet addiction, as well as an addiction more generally. Taken together, the associations between compulsivity and hypersexuality and compulsivity and problematic use appear relatively weak.

There is a current debate regarding how best to consider problematic sexual behaviors (such as hypersexuality and problematic pornography use), with competing models proposing classifications as impulse-control disorders, obsessive-compulsive spectrum disorders, or behavioral addictions. Relationships between transdiagnostic features of impulsivity and compulsivity and problematic sexual behaviors should inform such considerations, although both impulsivity and compulsivity have been implicated in addictions.

The finding that impulsivity related moderately to hypersexuality provides support both for the classification of compulsive sexual behavior disorder (as proposed for ICD-11; World Health Organization as an impulse-control disorder or as a behavioral addiction. In considering the other disorders currently being proposed as impulse-control disorders (e.g., intermittent explosive disorder, pyromania, and kleptomania) and the central elements of compulsive sexual behavior disorder and proposed disorders due to addictive behaviors (e.g., gambling and gaming disorders), the classification of compulsive sexual behavior disorder in the latter category appears better supported. (Emphasis supplied)

Finally, all the physiological and neuropsychological studies published on porn users and porn addicts (often denoted as CSB) report findings consistent with the addiction model (as do studies reporting escalation or tolerance).

In 2016 George F. Koob and Nora D. Volkow published their landmark review in The New England Journal of Medicine: Neurobiologic Advances from the Brain Disease Model of Addiction. Koob is the Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and Volkow is the director of the National Institute on Drug Abuse (NIDA). The paper describes the major brain changes involved with both drug and behavioral addictions, while stating in its opening paragraph that sexual behavioral addictions exist:

We conclude that neuroscience continues to support the brain disease model of addiction. Neuroscience research in this area not only offers new opportunities for the prevention and treatment of substance addictions and related behavioral addictions (e.g., to food, sex, and gambling)….

RE: withdrawal symptoms. The fact is, withdrawal symptoms are not required to diagnose an addiction. First, you will find the language “neither tolerance nor withdrawal is necessary or sufficient for a diagnosis…” in both the DSM-IV-TR and DSM-5. Second, claiming that “real” addictions cause severe life-threatening withdrawal symptoms conflates physiological dependence with addiction-related brain changes. An excerpt from this 2015 review of literature provides a more technical explanation (Neuroscience of Internet Pornography Addiction: A Review and Update):

A key point of this stage is that withdrawal is not about the physiological effects from a specific substance. Rather, this model measures withdrawal via a negative affect resulting from the above process. Aversive emotions such as anxiety, depression, dysphoria, and irritability are indicators of withdrawal in this model of addiction [43,45]. Researchers opposed to the idea of behaviors being addictive often overlook or misunderstand this critical distinction, confusing withdrawal with detoxification [46,47].

As for recent studies, consider this graph from a 2017 study reporting the development and testing of a problematic porn use questionnaire. Note that substantial evidence of both “tolerance” and “withdrawal” was found in at-risk users and low-risk users.

Regarding the assertion that, “Sex addiction” was specifically excluded from the ICD-11 for insufficient evidence, actually, no, it wasn’t. As explained elsewhere, neither the ICD-11 nor the APA’s DSM-5 ever uses the word “addiction” to describe an addiction – whether it be gambling addiction, or heroin addiction. Both diagnostic manuals title such diagnoses as “disorders” instead. (Details about the peculiar last-minute exclusion of “Hypersexual Disorder” from the DSM-5 are found above under Excerpt #1.) Thus, “sex addiction” was never formally considered for inclusion in either manual (and consequently never “rejected” either).

As for the first link, it goes to a short Business Insider article, not to an official WHO statement. That’s right. Popular media is all the Slate article offers to support the authors’ wishful thinking. Even so, Prause/Klein/Kohut should have read the article before relying on it, as the only scientist quoted states that sexual behavior addictions exist:

Endocrinologist Robert Lustig told Business Insider earlier this year that many activities that can bring feelings of pleasure, like shopping, eating, playing video games, using porn, and even using social media all have addictive potential when taken to extremes. “It does the same thing to your central nervous system as all those drugs do,” he said. “It just doesn’t do the peripheral nervous system part. That doesn’t make it not addiction. It’s still addiction, it’s just that it’s addiction without the peripheral effects.”

Why didn’t the Slate article link to a scientific journal, such as this 2017 Lancet commentary, co-authored by CSBD work-group member Shane Kraus, Ph.D? Well, because the Lancet commentary says the empirical evidence supports CSBD being classified as an addictive disorder:

We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.

And as Kraus puts it, “This is definitely not the final solution, but it’s a good starting place for more research and treatment for people.”

Whatever you or your healthcare giver want to call it – “hypersexuality,” “porn addiction,” “sex addiction,” “out-of-control sexual behavior,” “cybersex addiction” – if the behaviors fall within the “Compulsive Sexual Behaviour Disorder” description, the condition can be diagnosed using ICD-11 the CSBD code.

Re: “six professional organizations.” Actually, the Slate article provided 3 links to “professional organizations” and one link to a 2012 David Ley blog post about the DSM-5 omitting Hypersexual Disorder (which was discussed under excerpt #1). Let’s take a closer look at this impressive-sounding support.

Link #1: Link goes to the infamous 2016 AASECT proclamation. AASECT is not a scientific organization and cited nothing to support the assertions in its own press release – rendering its opinion meaningless.

Finding AASECT’s tolerance of the “sex addiction model” to be “deeply hypocritical,” in 2014 Dr. Aaron set out to eradicate support for the concept of “sex addiction” from AASECT’s ranks. To accomplish his goal, Dr. Aaron claims to have deliberately sowed controversy among AASECT members in order to expose those with viewpoints that disagreed with his own, and then to have explicitly silenced those viewpoints while steering the organization toward its rejection of the “sex addiction model.” Dr. Aaron justified using these “renegade, guerilla [sic] tactics” by reasoning that he was up against a “lucrative industry” of adherents to the “sex addiction model” whose financial incentives would prevent him from bringing them over to his side with logic and reason. Instead, to effect a “quick change” in AASECT’s “messaging,” he sought to ensure that pro-sex addiction voices were not materially included in the discussion of AASECT’s course change.

Dr. Aaron’s boast comes across as a little unseemly. People rarely take pride in, much less publicize, suppressing academic and scientific debate. And it seems odd that Dr. Aaron spent the time and money to become CST certified by an organization he deemed “deeply hypocritical” barely a year after joining it (if not before). If anything, it is Dr. Aaron who appears hypocritical when he criticizes pro-“sex addiction” therapists for having a financial investment in the “sex addiction model”, when, quite obviously, he has a similar investment in promoting his opposing viewpoint

Several commentaries and critiques expose AASECT’s proclamation for what it truly is: sexual politics:

Link #2: Link goes to a statement by the Association for the Treatment of Sexual Abusers (ATSA). Nowhere does the position statement suggest that sex addiction does not exist. Instead ATSA reminds us that non-consensual sexual activity is sexual abuse (e.g., Harvey Weinstein) and “likely … not the result of sexual addiction.” Absolutely true.

Incidentally, it appears that both AASECT and the 3 kink organizations produced their proclamations in a desperate effort to stop the new “CSBD” diagnosis from going into the ICD-11. Evidently, the experts at the World Health Organization were not taken in by this jointly created paper tiger, as the new diagnosis appears in the implementation version of the ICD-11.

Link #4: Link goes to Sex Addiction: Rejected Yet Again by APA. Hypersexual Disorder Will NOT be Included in the DSM5. This David Ley post is noteworthy because it exemplifies the circular tactic employed throughout the Slate article by Ley’s close allies. When the DSM-5 rejected the umbrella diagnosis of “Hypersexual Disorder” Ley and his chums painted it as rejection of “Sex Addiction.” Yet when the ICD-11 included the umbrella diagnosis of “Compulsive Sexual Behavior Disorder” they painted it as excluding “Sex Addiction.” Why worry about internal inconsistencies, right? Just say black is white, and repeat in tweets, on listserves and Facebook and articles like this one by Klein/Kohut/Prause.

Next, back your spin up using an expensive PR firm. It can get you and your propaganda placed in dozens of different mainstream media outlets, touting you as world experts. It matters not if you aren’t an academic, haven’t been affiliated with a university for years, or obtained your PhD from an unaccredited sexology institution.

SLATE EXCERPT: Speaking to the heart of the issue, one of the biggest problems for some porn users is shame. Shame about viewing sex films is heaped on the public by the sex-addiction treatment industry (for profit), by the media (for clickbait), and by religious groups (to regulate sexuality). Unfortunately, whether you believe porn viewing is appropriate or not, stigmatizing sex-film viewing may be contributing to the problem. In fact, an increasing number of studiesshow that many people who identify as “porn addicted” do not actually view sex films more than other people. They simply feel more shame about their behaviors, which is associated with growing up in a religious or sexually restrictive society.

SLATE EXCERPT: The decision to include sexual compulsivity in ICD-11 strikes us as odd because the exact diagnostic criteria that were chosen have never been tested. Specifically, the ICD-11 asserts that anyone distressed about their frequent sexual behaviors due purely to “moral judgments and disapproval about sexual impulses, urges, or behaviours” should be excluded from diagnosis. However, moral judgments and disapproval are the strongest predictors of someone believing that they are addicted to pornography in the first place.

The following is a combined response to excerpts 15 and 19 as both deal with a single pornography questionnaire (CPUI-9) and the studies that employ it.

Note: The core claim put forth in both excerpts is false as there is only one study that directly correlated self-identification as a porn addict with hours of use, religiousness and moral disapproval of porn use.Its findings contradict the carefully constructed narrative about “perceived addiction” (that “porn addiction is just religious shame/moral disapproval”) – which is grounded in studies employing the
flawed instrument called the CPUI-9. In the only direct-correlation study, the strongest correlation with self-perception as an addict was with hours of porn use. Religiousness was irrelevant, and while there was predictably some correlation between self-perception as an addict and moral incongruence regarding porn use, it was roughly half the hours-of-use correlation.

Here we present a relatively short synopsis of the Joshua Grubbs questionnaire (CPUI-9), the myth of “perceived pornography addiction,” and what the relevant data actually reveal. Since this involves a complex and tangled web with many layers, these three articles and a presentation were produced to fully explain the CPUI-9 studies:

To understand how the only direct-correlation research undermines all of the CPUI-9 studies, more background is helpful. The phrase “perceived pornography addiction” indicates nothing more than a number: the total score on the following 9-item pornography-use questionnaire with its three extraneous questions. The key insight is that the CPUI-9 includes 3 “guilt and shame/emotional distress” questions not normally found in addiction instruments. These skew its results, causing religious porn users to score higher and non-religious users to score lower than subjects do on standard addiction-assessment instruments. It doesn’t sort the wheat from the chaff in terms of perceived vs. genuine addiction. Nor does the CPUI-9 assess actual porn addiction accurately.

Perceived Compulsivity Section

I believe I am addicted to Internet pornography.

I feel unable to stop my use of online pornography.

Even when I do not want to view pornography online, I feel drawn to it

Access Efforts Section

At times, I try to arrange my schedule so that I will be able to be alone in order to view pornography.

I have refused to go out with friends or attend certain social functions to have the opportunity to view pornography.

I have put off important priorities to view pornography.

Emotional Distress Section

I feel ashamed after viewing pornography online.

I feel depressed after viewing pornography online.

I feel sick after viewing pornography online.

Subjects never “label themselves as porn addicts” in any Grubbs study: They simply answer the 9 questions above, and earn a total score.

The term “perceived pornography addiction” is misleading in the extreme, because it’s just a meaningless score on an instrument that produces skewed results. But people have assumed they understood what “perceived addiction” meant. They presumed it meant that the CPUI-9’s creator, Grubbs, had figured out a way to distinguish actual “addiction” from “belief in addiction.” He hadn’t. He had just given a deceptive label to his “porn use inventory,” the CPUI-9. Grubbs has made no effort to correct the misperceptions about his work that rolled out into the media, pushed by anti-porn addiction sexologists and their media chums.

Misled journalists mistakenly summed up CPUI-9 findings as:

Believing in porn addiction is the source of your problems, not porn use itself.

Religious porn users are not really addicted to porn (even if they score high on the Grubbs CPUI-9) – they just have shame.

The Key: the Emotional Distress questions (7-9) cause religious porn users to score much higher and secular porn users to score far lower, as well as creating a strong correlation between “moral disapproval” and total CPUI-9 score (“perceived addiction”). To put it another way, if you use only results from CPUI-9 questions 1-6 (which assess the signs and symptoms of an actual addiction), the correlations dramatically change – and all the dubious articles claiming shame is the “real” cause porn addiction would never have been written.

Tips for understanding the numbers in the table: zero means no correlation between two variables; 1.00 means a complete correlation between two variables. The bigger the number the stronger the correlation between the 2 variables.

In this first correlation we see how moral disapproval correlates powerfully with the 3 guilt and shame questions (Emotional Distress), yet weakly with the two other sections that assess actual addiction (questions 1-6). The Emotional Distress questions cause moral disapproval to be the strongest predictor of total CPUI-9 scores (“perceived addiction”).

But if we use only the actual porn addiction questions (1-6), the correlation is pretty weak with Moral Disapproval (in science-speak, Moral Disapproval is a weak predictor of porn addiction).

The second half of the story is how the same 3 Emotional Distress correlate very poorly with levels of porn use, while the actual porn addiction questions (1-6) correlate robustly with porn use levels.

This is how the 3 Emotional Distress questions skew results. They lead to reduced correlations between “hours of porn use” and total CPUI-9 scores (“perceived addiction”). Next, the sum total of all 3 sections of the CPUI-9 test is deceptively re-labeled as “perceived addiction” by Grubbs. Then, at the hands of determined anti-porn-addiction activists, “perceived addiction” morphs into “self identifying as a porn addict.” The activists have pounced on the strong correlation with moral disapproval, which the CPUI-9 always produces, and presto! they now claim that, “a belief in porn addiction is nothing more than shame!”

It’s a house of cards built on 3 guilt and shame question not found in any other addiction assessment, in combination with the misleading term the questionnaire’s creator uses to label his 9 questions (as a measure of “perceived porn addiction”).

Second, our findings cast doubts on the suitability of the inclusion of the Emotional Distress subscale as part of the CPUI-9. As consistently found across multiple studies (e.g., Grubbs et al., 2015a,c), our findings also showed that frequency of IP use had no relationship with Emotional Distress scores. More importantly, actual compulsivity as conceptualized in the present study (failed abstinence attempts x abstinence effort) had no relationship with Emotional Distress scores.

Emotional Distress scores were significantly predicted by moral disapproval, in line with previous studies which also found a substantial overlap between the two (Grubbs et al., 2015a; Wilt et al., 2016)…. As such, the inclusion of the Emotional Distress subscale as part of the CPUI-9 might skew results in such a way that it inflates the total perceived addiction scores of IP users who morally disapprove of pornography, and deflates the total perceived addiction scores of IP users who have high Perceived Compulsivity scores, but low moral disapproval of pornography.

This may be because the Emotional Distress subscale was based on an original “Guilt” scale which was developed for use particularly with religious populations (Grubbs et al., 2010), and its utility with non-religious populations remains uncertain in light of subsequent findings related to this scale.

Here’s is the core finding: The 3 “Emotional Distress” questions have no place in the CPUI-9, or any porn addiction questionnaire. These guilt and shame questions do not assess distress surrounding addictive porn use or “perception of addiction.” These 3 questions merely artificially inflate total CPUI-9 scores for religious individuals while deflating total CPUI-9 scores for nonreligious porn addicts.

EXCERPT #20: A study accused of using porn stars as its subjects and funded by a controversial for-profit company trying to legitimize its very expensive sexual technique…yeah, that will debunk porn addiction

SLATE EXCERPT: More importantly, we have no laboratory studies about actual sexual behaviors in those who relabport this difficulty. The first study of partnered sexual behaviors in the laboratory, which tests the compulsivity model, is currently under peer review at a scientific journal. (Disclosure: One of this article’s co-authors, Nicole Prause, is the lead author of that study.) The World Health Organization should wait to see if any science supports their novel diagnosis before risking pathologizing millions of healthy people.

“We have no laboratory studies?” Not so. There are plenty of laboratory studies published on porn’s immediate effects on the viewer (listed in Excerpt #9). More importantly, there are 39 “laboratory studies” assessing brain functions and structures in porn users and those with CSB.

Will Prause’s upcoming “laboratory study” negate hundreds of studies performed over the last few decades? Highly unlikely as we already know a great deal about her upcoming research on “partnered sexual behaviors.” Both Prause and the lucrative commercial enterprise that funded this research have been crowing about it for years.

In fact, all existing indications are that her partnered subjects will not be doing anything relevant to this article by Prause/Kohut/Klein. Here’s what we know about this as yet unpublished work: Prause was commissioned by the California company that her website lists as her major source of income, Orgasmic Meditation (also called ‘OM’ and ‘OneTaste’), to study the benefits of clitoral stroking. From Prause’s Liberos website:

OneTaste charges high fees to attend workshops where participants learn “orgasmic meditation” (how to stroke women’s clitorises). This enterprise has recently received some unflattering, revealing publicity. Here are the news items:

The newish CEO is betting that the study OneTaste has funded on the health benefits of OM, which has taken brain-activity readings from 130 pairs of strokers and strokees, will draw fresh crowds. Led by researchers from the University of Pittsburgh, the study is expected to yield the first of multiple papers later this year. “The science that’s coming out to back what this is and what the benefits are is going to be huge in terms of scaling,” Van Vleck says

Regardless of the fact that Prause’s OM research business is addressing partnered clitoral stroking, she is already hinting (as here) or openly claiming (elsewhere) that it invalidates the ICD-11’s new “Compulsive sexual behavior disorder” (CSBD) diagnosis. (Much as her diametrically opposed results in her 2013 and 2015 studies both somehow debunked sex addiction.) In short, whatever research this scientist is hired to perform, you can bet she will claim it debunks porn and sex addiction, as well as the new CSBD that will be used to diagnose both!

Incidentally, where did Prause obtain subjects for her clitoral-stroking investigation? According to tweets by an adult performer, Prause obtained porn performers as OM study subjects, via the most powerful lobbying arm of the porn industry, the Free Speech Coalition. See this Twitter exchange between Prause and adult performer, Ruby the Big Rubousky, who is vice president of the Adult Performers Actors Guild (Prause has since deleted this thread):

Prause has been quick to accuse others of bias without supplying any hard evidence whatsoever, but her OM research is a powerful example of an egregious conflict of interest: taking hundreds of thousands of dollars to find benefits of a dubious, commercially driven practice…and possibly obtaining subjects via the most powerful lobbying arm of the porn industry. All while conveniently serving the porn industry by also claiming this research invalidates the new CSBD diagnosis that will be used for those suffering from compulsive sexual behaviors (more than 80% of whom report problems with internet pornography use).

Since this page was first created Prause has targeted others, including researchers, medical doctors, therapists, psychologists, former UCLA colleagues, a UK charity, men in recovery, a TIME magazine editor, several professors, IITAP, SASH, Fight The New Drug, the academic journal Behavioral Sciences, its parent company MDPI, US Navy medical doctors, the head of the academic journal CUREUS, and the journal Sexual Addiction & Compulsivity. These incidents are in the “OTHERS” sections. Several additional incidents have occurred that we are not at liberty to divulge – as Prause’s victims fear further retribution. This page is arranged roughly in chronological order.

Important point: While Prause continues to falsely claim she is “the victim,” it is Prause who initiated all contact and harassment towards the individuals and organizations listed on this page. No one on this list has harassed Nicole Prause. Her fabricated claims about being a victim of “stalking” or misogyny from “anti-porn activists” lack one iota of documentation. All the evidence she provides is self-generated: a single info-graphic, a few emails from her to others describing harassment, and five spurious cease and desist letters containing false allegations. You will also see evidence of a number of formal complaints Prause has filed with various regulatory agencies – which have been summarily dismissed or investigated and dismissed. She seems to file these bogus complaints so she can then go on to claim her targets are all “under investigation.”

Update: In an attempt to hide her egregious behavior Prause has deleted many of the tweets linked to on this page and has filed 3 bogus, and unsuccessful, DMCA takedowns to have the screenshots of her tweets removed. Why would someone with nothing to hide delete over 3,000 tweets?

In The Beginning – March & April 2013: The beginning of Nicole Prause’s libel, threats and harassment (after she & David Ley target Wilson in a PT blog post)

Key point: Prause initiated all direct contacts with Gary Wilson. Prause continues to publicly harass and libel Wilson while simultaneously (falsely) claiming he is under a court’s “no contact” order. This is like punching an innocent person in the face while simultaneously screaming “Stop hitting me!”

March 5, 2013

Author of “The Myth of Sex Addiction,” David Ley, and Nicole Prause team up to write a Psychology Today blog post with the strategic title: “Your Brain on Porn – It’s NOT Addictive.” (Your Brain On Porn is a website founded by Wilson.) It was about Nicole Prause’s unpublished, yet to be peer-reviewed EEG study (“Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images”).

It’s important to note that only Ley received access to Prause’s unpublished study (it was published 5 months later). The blog post linked to Wilson’s ‘Your Brain on Porn’ website and suggested that YBOP was in favor of banning porn (untrue).

Second key point: Five months before Prause’s EEG study (Steele et al., 2013) was published, both Prause and Ley were targeting Gary Wilson and his website.

March 7, 2013

Wilson published a Psychology Today blog post responding to the content in the David Ley post. Ley’s blog post and Wilson’s response were eventually removed by Psychology Today editors, as the underlying study wasn’t yet available. You can find the original Ley and Wilson blog posts archived here. It’s important to note that Wilson’s blog post clearly states it was only responding to Ley’s description of the Prause study. Later Nicole Prause would falsely accuse Wilson of misrepresenting her study (that only she and Ley had seen, and were making public claims about – which were later shown to be unfounded).

“Hey David – I’m wondering how you got your hands on a study that has yet to published, or mentioned anywhere else. Are you willing to send me a copy?”

David Ley did not respond.

April 10, 2013

In response to the above comment, Prause contacted the Psychology Today editors, commented under my PT article, and emailed Wilson the following. In the email, Prause attacks Wilson personally, and mistakenly states that he did not ask for the study. He had, in fact, asked David Ley for it. The email:

It is illegal for you to misrepresent our science having never even requested a copy of the manuscript. It will be treated as such. Our article actually is very balanced. Unlike you, I have peer-reviewed publications on both sides of this issue. You have attempted to discredit it by describing things that were not done. I am pursuing this with Psychology Today now, but I would advise you to remove the post yourself before I am forced to pursue further action.

You also do not have permission to quote any portion of this email. It is private communication.

Sell your books on your own merit. Don’t try to make money off the backs of scientists doing their jobs. I can tell this study clearly panics you because the design and data are strong, but it is egregious to have not even asked for a copy of the manuscript and just make up content. Shame on you.

Nicole Prause, PhD
Research faculty
UCLA

In addition, Psychology Today editors forwarded a second email from Prause:

Date: April 10, 2013 5:13:30 PM EDT
Topic: Comment on the Blogs

From: Nicole Prause, PhD <nprause@_____________

To whom it may concern:

I was surprised to see an article written about a study of mine by Gary Wilson on Psychology Today.

I have no problem with him representing his own views and interpretations of studies, but he does not and could not have had access to mine. It is under review and he never requested a copy from any of the authors. I notified him that it should be removed. He has not yet done so. Of course, once it is public record, he will have access to it and be able to represent it (hopefully) more accurately.

Of course, knowingly misrepresenting a person to denigrate them is illegal. I hope Psychology Today will take this matter seriously. I will contact other board members as well, in case your cue is full and may take longer to respond.

Unfortunately, these authors never requested access to our manuscript, so they actually did not review it. They have made a number of egregious errors misrepresenting the science in this article. I am investigating who to contact to remove this article given the lack of due diligence by the authors.

We are now using this as our course example of the misrepresentation of science in the media now, though, so thank you for that opportunity.

The groundless legal threats, false claims, and playing the victim begin in her very first contact with Wilson. Nothing Prause says is true:

Wilson did not describe Prause’s study or misrepresent it in any way. He only responded to Ley’s description of the study. Read Ley’s and Wilson’s blog posts and judge for yourself.

To this day Prause has yet to refute a single word in Wilson’s March, 2013 Psychology Today post, or the analysis Wilson wrote in July after her EEG study finally was published. Nor has Prause refuted a single word in six peer-reviewed critiques of her 2013 EEG: 1, 2, 3, 4, 5, 6.

Wilson makes no money off of this endeavor.

Wilson asked for a copy of the study (Prause refused to supply it).

Prause initiated all contact with Wilson.

Wilson’s email response to Nicole Prause:

On Wed, Apr 10, 2013 at 3:14 PM, gary wilson <> wrote:

Hi Nicole,

I commented under your comment. Have a look.

We make no money on this. My website has no advertising and we accept no donations. We have no services to sell. I have no book to sell. My wife’s book, which appears on PT, is not about porn.

If you want to be truly fair, please send us the full study and give us permission to blog about it – as you did with Dr. Ley.

I’ll be anticipating your study,

Gary Wilson

April 12, 2013

Two days later Prause contacted Wilson again threatening further legal action. She somehow tracked down one of Wilson’s comments on the porn-recovery site Your Brain Rebalanced. It was posted on a long thread about David Ley’s original blog post. Wilson’s comment was meant to explain why both Ley’s and Wilson’s Psychology Today posts had been removed by Psychology Today. This signaled Prause’s pattern of cyberstalking, as a not even a Google search could locate that post. How did Prause know about this thread on a porn recovery forum?

This is libel. Please remove this post or I will follow up with legal action.

Nicole Prause

Wilson responds:

On Fri, Apr 12, 2013 at 11:09 AM, gary wilson <> wrote:

Dear Nicole Prause,

Maybe you didn’t know that my wife is a graduate of Yale law school. I said nothing libelous. In fact, my statements are quite accurate.

1) You have refused to hand over your unpublished study.

2) You were nasty and threatening, as you are now.

3) In addition, you falsely stated that I make money from guys struggling to recover from porn addiction.

4) You also mischaracterized my PT post, as it was a clear response to David Ley’s description of your unpublished study. You chose not correct Ley’s description or make the full study available to me, even when I asked about it in the comment section one month ago.

You have yet to answer my original questions (posed in the comments section):

1) Why did you release your study to only David Ley? As the author of the “Myth of Sex Addiction,” and someone who claims porn addiction cannot exist, why was only he the only Chosen One?

2) Why haven’t you corrected David Ley’s interpretation of your study? It has been up for over a month, and you’ve commented twice on it in the last month.

3) You commented under Ley’s post one month ago. I immediately posted a comment under you comment, with several specific questions directed to you about your study. That was your chance to both respond and offer the study. You did neither. Why?

I’m fine with making our exchange public. Won’t it be interesting when you file a lawsuit against a couple of PT bloggers who dare to take on your research?

Best,
Gary Wilson

Prause emails again with more crazy claims & legal threats [Note: Neither Wilson nor his wife ever initiated contact with Prause. She is the one who repeatedly contacted them and threatened them with groundless legal action.]

This is to notify both you and your wife that your (both you and your wife’s) contact is unwanted. Per stalking statutes in your home state (http://courts.oregon.gov/Lane/Restraining.page), any additional harassing contact will be interpreted as actionable harassment.

You do not have my permission to share this private communication in any forum.

Nicole Prause

Wilson sends his final email to Prause, to set the record straight: that she is the one initiating all contact and the only person making threats (and false claims):

Harassment? I have not initiated one email exchange with you, including this one.
The first, initiated by you on 4/10/13, where you had the last email. And the one below, where you are trying to create a false impression that someone is harassing you, when in fact you are threatening me for the second time.

You are also the one who contacted Psychology Today’s editor to interfere with my blog post. My wife has had no contact with you whatsover.

We do not need your permission.

Gary Wilson

The end of the beginning with Nicole Prause.

Note: The above email exchange has been touted by Prause as as “a no-contact order”. It’s not. Prause continues to harass Wilson on social media and behind the scenes, while simultaneously claiming that Wilson has been barred from responding to her lies. While Prause ends many of her targeted social media attacks by asserting a “no-contact request”, there is no such thing. A “no-contact request” is as legally binding as requesting someone “stop and smell the roses”.

Prause is trying to trick the public (her twitter followers) into believing she has obtained a restraining order or an injunction. She hasn’t. Its just a tweet. But that doesn’t stop her from publicly and falsely accusing her victims of “violating no contact orders” and of “harassment.” The clear, and clearly false, implication of her statements is to suggest these people are acting illegally. Her aggressive tactics and knowingly false accusations are calculated to bully and intimidate the victims of her online cyber-harassment into silence.

In late July 2013 Prause’s EEG study (Steele et al., 2013) was finally published. It arrived with much press coverage, including this Prause Interview by a Psychology Today blogger: New Brain Study Questions Existence of “Sexual Addiction.” A few days later Gary Wilson published his detailed analysis of Steele et al., 2013 and Prause’s claims put forth in the above interview and elsewhere. Wilson posted it on his Psychology Today blog as Nothing Correlates With Nothing In SPAN Lab’s New Porn Study. Incidentally, Psychology Today, apparently in response to Prause’s threats, ultimately unpublished not only Wilson’s critique of this study, but also the critiques of two professional experts in the field who wrote about the study’s weaknesses.

Ultimately, Prause’s findings and claims in the media were re-analyzed and critiqued repeatedly by various other experts and by seven peer-reviewed papers:1, 2, 3, 4, 5, 6, 7.

All five papers agree with Gary Wilson’s analysis that Steele et al. actually supports the porn addiction model, and that Prause misrepresented her findings to the press. Prause’s two claims versus the study’s actual findings:

1) Prause claimed that subjects “brains did not respond like other addicts”.

Reality: The study had no control group for comparison. More importantly, the study reported higher EEG readings (relative to neutral pictures) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction (see more).

Reality: In line with the Cambridge University brain scan studies, Steele et al. reported greater cue-reactivity (higher EEG readings) to porn correlating with less desire for partnered sex. To put another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Prause claimed that porn users merely had “high libido”, yet the results of the study say the exact opposite: their desire for partnered sex was dropping in relation to their porn use (see more).

With her unsupported claims exposed by Gary Wilson, John A. Johnson PhD and Don Hilton MD, Prause then resorted to behind the scenes maneuvering at Psychology Today, cyberstalking, and various forms of intimidation. To this day Prause and others continue to cite her work as “debunking the field,” without mentioning or offering any response to any of the formal criticism apart from ad hominem attacks on some of the authors.

Within a few days of publishing Wilson’s critique, various usernames began posting comments wherever Gary Wilson’s name appeared. The comments are very similar in content and tone, falsely claiming that 1) Wilson had never taught anatomy, physiology, pathology or attended college, 2) Wilson stole a woman’s pictures and placed them on a porn site, 3) Wilson has a police report filed on him, 4) Wilson is an unemployed massage therapist, 5) Wilson is charged with stalking a poor woman, 6) Wilson has been reported to LAPD, UCLAPD and the FBI. These same false assertions are made by no other Wilson critic and continue to this day in tweets and comments by Prause and by her many sockpuppets.

The above claims are ludicrous, but the lies about stolen “pictures on a porn site“, “a police report has been filed“, “stalking a pooor woman/scientist” and “unemployed massage therapist” incriminate Prause as the cyberstalker posting the 2013 comments and the dozens of fake usernames with hundreds of comments over the next 5 years. (Note – A call to the Los Angeles police and the UCLA campus police revealed no such report in their systems.) Below is an example taken from Wilson’s YouTube inbox (7/26/13):

Key point: Both the cyberstalker and Nicole Prause have stated that Wilson “stole photos of a woman” and “had a police report on file for stealing these photos.”

1) “Photos stolen” “on a porn site”

Here’s the reality: Gary Wilson wrote this Psychology Today blog post about this Nicole Prause Psychology Today Interview (which contains a picture of Prause). Psychology Today required at least one picture (all of Wilson’s Psychology Today articles contained several pictures). Since this blog post was about Nicole Prause’s interview and her EEG study, it seemed appropriate to use a picture of Prause from a UCLA website. The picture that accompanied Wilson’s Psychology Today blog post was also used with this same article on YBOP.

The photo of Prause came from what Wilson reasonably assumed was a UCLA website – SPAN Lab – and it was apparently the photo Prause had chosen to represent herself. Everything about SPAN Lab’s website gave the impression it was owned and run by UCLA. At the bottom each SPAN Lab page was the following (Prause has recently forbidden the “Internet WayBack Machine” from showing SPAN Lab’s archive pages, so as to conceal this fact):

It was unclear how Prause could be claiming copyright to a photo that was on a website that claimed its copyright was owned by UCLA. UCLA is a California state school answering to taxpayers. Presumably, its images are public. Many months later when Wilson wrote UCLA concerning Prause’s libelous PDF (below), UCLA stated that SPAN Lab was Prause’s site, and not on UCLA servers(!). Why did Prause misrepresent her website as being owned by UCLA? That was the first time Wilson learned this. Undisputed fact: Prause never contacted Wilson to request that her picture be removed from the blog post. Wilson knew nothing until Prause filed a DMCA request (below) and Wilson found the picture missing from the article critiquing Prause’s interview and study.

So, that’s the “stolen photo’s” claim: A single picture, selected by Prause herself, from (what appeared to be) a UCLA lab website was used in an article about a study published and promoted by UCLA & Nicole Prause. The “porn site” was YBOP, a claim that is laughable, as it is a porn recovery support website without x-rated content.

Addendum: Prause is now claiming in an AmazonAWS PDF that Wilson migrated the picture of Prause (and the associated article) to other servers. This is completely false. The picture of Prause accompanied a single critique that appeared on two separate websites, PornStudySkeptics and YourBrainOnPorn.com. These two identical articles have remained on those two websites since July, 2013: Article 1, Article 2. In her PDF Prause also claims that Wilson’s ISP told him that they would “close his website if he did it a fourth time.” This is fabricated nonsense.

2) “police report filed”

It’s been over 5 years and Wilson has never been contacted by the police (a call to the Los Angeles police department and the UCLA campus police revealed no such report in their systems). Although Prause has repeated this undocumented claim dozens of times, she has also failed to divulge what law Wilson supposedly violated. In 2018, she added the tall-tale that Wilson was twice reported to the FBI. What’s next, the CIA, ICE, Homeland Security… maybe a mall cop? (Addendum: Gary Wilson filed a freedom of information request with the FBI and the FBI confirmed that Prause was lying: no report has ever been filed on Wilson. See – November, 2018: FBI affirms Nicole Prause’s fraud surrounding defamatory claims)

Evidence directly connecting Prause to these many groundless comments about “stolen pictures” and “a police report.”

Prause filed a DMCA take down of her SPAN Lab picture on July 21, 2013 – http://www.chillingeffects.org/dmca512c/notice.cgi?NoticeID=1091617 and the server removed it before Wilson saw the related email notices. Wilson removed the photo from its other location when asked via a second DMCA filing, even though UCLA, not Prause, appeared (as far as he could tell) to be the copyright owner.

Prause has tweeted that she filed a police report on Wilson (see details below under “Prause & Ley attack NoFap founder Alexander Rhodes“). A call to the LAPD and UCLA campus police revealed no such report in their system.

Nicole Prause published a PDF on her SPAN Lab website (more on this in the next section) with all the usual claims and lies echoing all the preceding comments. It also lied that:

“Wilson has been found guilty of stealing other people’s images”

Again, this was apparently a reference to the same picture that accompanied the Psychology Today post, and the Psychology Today post was about Prause’s interview on Psychology Today. It was the same picture she had chosen for the top of her SPAN Lab website (which falsely proclaimed it was a UCLA site).

Most of these comments claimed that Wilson “stole” and placed Prause’s picture on a pornographic website.

Prause never contacted Wilson about the picture.

Prause filed a DMCA take down of her picture, which forced the company hosting YBOP to remove the picture without first contacting Gary Wilson.

Similar groundless comments continue to be posted to this day by Prause sockpuppets and by Prause on her twitter and Facebook accounts. The comments are often identical to the July, 2013 “anonymous” comments (many more examples below and on page 2)

At the same time that Prause was engaging in cyberstalking and threatening groundless legal action against Wilson, she went after senior psychology professor emeritus John A. Johnson. Prause was enraged by Johnson’s saying that spokesperson Prause made claims that did match her actual results (as Wilson had also said). Commenting under the Psychology Today interview of Nicole Prause, Professor John A. Johnson commented twice:

Mustanski asks, “What was the purpose of the study?” And Prause replies, “Our study tested whether people who report such problems [problems with regulating their viewing of online erotica] look like other addicts from their brain responses to sexual images.”

But the study did not compare brain recordings from persons having problems regulating their viewing of online erotica to brain recordings from drug addicts and brain recordings from a non-addict control group, which would have been the obvious way to see if brain responses from the troubled group look more like the brain responses of addicts or non-addicts.

Instead, Prause claims that their within-subject design was a better method, where research subjects serve as their own control group. With this design, they found that the EEG response of their subjects (as a group) to erotic pictures was stronger than their EEG responses to other kinds of pictures. This is shown in the inline waveform graph (although for some reason the graph differs considerably from the actual graph in the published article).

So this group who reports having trouble regulating their viewing of online erotica has a stronger EEG response to erotic pictures than other kinds of pictures. Do addicts show a similarly strong EEG response when presented with their drug of choice? We don’t know. Do normal, non-addicts show a response as strong as the troubled group to erotica? Again, we do not know. We don’t know whether this EEG pattern is more similar to the brain patterns of addicts or non-addicts.

The Prause research team claims to be able to demonstrate whether the elevated EEG response of their subjects to erotica is an addictive brain response or just a high-libido brain response by correlating a set of questionnaire scores with individual differences in EEG response. But explaining differences in EEG response is a different question from exploring whether the overall group’s response looks addictive or not. The Prause group reported that the only statistically significant correlation with the EEG response was a negative correlation (r=-.33) with desire for sex with a partner. In other words, there was a slight tendency for subjects with strong EEG responses to erotica to have lower desire for sex with a partner. How does that say anything about whether the brain responses of people who have trouble regulating their viewing of erotica are similar to addicts or non-addicts with a high libido?

My mind still boggles at the Prause claim that her subjects’ brains did not respond to sexual images like drug addicts’ brains respond to their drug, given that she reports higher P300 readings for the sexual images. Just like addicts who show P300 spikes when presented with their drug of choice.

How could she draw a conclusion that is the opposite of the actual results? I think it could be due to her preconceptions–what she expected to find. I wrote about this elsewhere. http://www.psychologytoday.com/blog/cui-bono/201308/preconceptions-may-color-conclusions-about-sex-addiction

When I first conceived this blog post and began to compose it about a month ago, my original intention was to describe in exquisite detail the specific ways in which I saw the proponents of opposite sides of the debate exaggerating or overextending their arguments beyond the actual data in the study. I subsequently changed my mind when I observed a firestorm of emotionally-charged rhetoric erupting among the debate participants. Not arguments about what the data logically implied, but ad hominem threats, including threats of legal action. I saw a PT blog post disappear, apparently because one of the parties demanded that it be taken down. I even received a couple of angry emails myself because one of the parties had heard that I had raised questions about the proper interpretation of the research in question in a scientific forum.

So, I have decided to quietly tip-toe out of the room. I have also decided to go ahead and post here what I had already composed a month ago, simply to present an example of my empirical claim that science is not a purely objective enterprise, and that actual scientists can become very personally and emotionally involved in their work. The controversy in question is also an excellent example of a common trend among U.S. researchers to overestimate soft-science results.

November 2013: Prause places a libelous PDF on her SPAN Lab website. Content mirrors “anonymous” comments around the Web

In November 2013, Nicole Prause placed a PDF on her SPAN Lab website attacking Gary Wilson (screenshot below). It contained several instances of libel. The PDF’s contents are very similar to hundreds of other comments that were posted by various usernames. Posts were written by GaryWilson Stalker, GaryWilson IsAFraud and other sock puppets. Such comments continue to this day on various recovery forums and other venues, posted with other usernames.

If there was ever any doubt as to who was actually behind these comments, the PDF puts an end to it. Gary Wilson contacted UCLA to report the PDF’s defamatory statements, as he still believed SPAN Lab was a UCLA website (at the time, SPAN Lab’s copyright was owned by UCLA and its address was within a UCLA building). UCLA acknowledged the existence of the PDF, and its subsequent removal in a letter. Its URL was – http://www.span-lab.com/WilsonIsAFraud.pdf.

How did Gary Wilson discover the above PDF? His Internet browser was redirected to the PDF when he visited the SPAN lab website (representing itself as a UCLA website). Knowing Wilson’s IP address, Prause made a habit of redirecting Wilson’s Internet browser to other URLs, such as porn sites or pictures of mutilated penises. This started before the PDF appeared, and continued after the PDF was removed. More evidence that Prause is likely the one responsible for cyberstalking events (only a small portion of which are detailed on this page). For example, two PDFs containing material nearly identical to Prause’s libelous PDF were uploaded onto DocStoc a few days after Wilson published his critique of Prause’s 2013 EEG study:

Contrary to claims the “documents” show nothing, except that Prause is the person who published both PDFs. Wilson complained to UCLA about Prause’s libelous PDF. The UCLA reply:

In the beginning Prause employed dozens of fake usernames to post on porn recovery forums, Quora, Wikipedia, and in the comment sections under articles. Prause rarely used her real name or her own social media accounts. That all changed after UCLA chose not to renew Prause’s contract (around January, 2015).

Prause began to put her name to falsehoods, openly cyber-harassing multiple individuals and organizations on social media and elsewhere. Since Prause’s primary target was Gary Wilson (hundreds of social media comments along with behind the scenes email campaigns), it became necessary to monitor and document Prause’s tweets and posts. This was done for her victims’ protection, and crucial for any future legal actions.

It soon became apparent that Prause’s tweets and comments were rarely about sex research, neuroscience, or any other subject related to her claimed expertise. In fact, the vast majority of Prause’s posts could be divided into two overlapping categories:

Defamatory & ad hominem comments targeting individuals and organizations that she labeled as “anti-porn activists” (often claiming to be a victim of these individuals and organizations).

countless misrepresentations of the state of pornography research and attacks on porn studies or porn researchers

This page contains a sampling of tweets and comments related to #2 – her vigorous support of the porn industry and its chosen positions. After years of sitting on the evidence, YBOP is of the view that Prause’s unilateral aggression has escalated to such frequent and reckless defamation (falsely accusing her many victims of “physically stalking her,” “misogyny,” “encouraging others to rape her,” and “being neo-nazis”), that we are compelled to examine her possible motives. The page is divided into 3 main sections:

December 2013: Prause’s initial tweet is about Wilson & the CBC: “RealScience” posts same false claims on same day on multiple websites

On December 18, 2013 Nicole Prause’s maiden tweet for her new Twitter account was about Gary Wilson and a CBC interview. We can’t link to the tweet as Prause’s original Twitter account was permanently suspended for harassing Todd Love, PsyD, JD, whose review of the literature dared to criticize her work (more below). Prause’s original Twitter URL was https://twitter.com/NicolePrause/. If interested you can read Wilson’s response to the CBC here.

On December 18th & 19th “RealScience” or “RealScientist” posted several similar, equally misleading comments on sites that mentioned Gary Wilson. Who else but Prause could be responsible for these posts, which entirely misrepresent the exchange with the CBC and its response to Wilson? A few examples, where Prause lies not only about about the CBC, but also my credentials, my education, and the courses I have taught:

Prause posting on YourBrainRebalanced, using a name other than “RealScience”:

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Tweeting about CBC in 2016 falsely claiming that Wilson threatened the CBC.

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In the next section Prause (“RealScience”) posts her CBC drivel on porn recovery forum YourBrainRebalanced, and asks Gary Wilson about the size of his penis. Prause transforms Wilson’s reply to her penis question (where he accidentally typed “Miss Prause”) into a campaign defaming Wilson and his wife misogynists. Not kidding.

Here’s an enlarged version of the image she included in the above tweet. Link to Wilson’s full answer. It is Prause who is being sexist as Prause asks Gary Wilson about the size of his penis:

Nevertheless, Prause has transformed Wilson’s inadvertently typing “Miss” in his reply to her questions about his manhood into her never ending campaign to paint Wilson, and others as misogynists. Below are just a few examples of how Prause has weaponized her bizarre interest in Gary Wilson’s penis, and his response.

Over the last few years, Dr. Prause appears to have taken great pains to position herself as a “woman being subjected to misogynistic oppression when she tells truth to power.” She frequently tweets the following infographic that she apparently also shares at her public lectures, suggesting she is being victimized “as a woman scientist,” and painting herself as a trailblazer forging ahead to prove porn’s harmlessness despite prejudiced attacks.

It accuses Wilson, Marnia Robinson, Don Hilton MD, and nofap founder Alexander Rhodes of misogyny. Any suggestion that Wilson (or his wife), Hilton, or Rhodes are motivated by misogyny is fabricated, as their objections have nothing to do with Dr. Prause as a person or as a woman, and only to do with her untrue statements and inadequately supported claims about her research.

It’s ironic that her infographic contains four instances of misogyny taken from anonymous YouTube comments under her TEDx talk. In 2013, TED closed comments under Gary Wilson’s TEDx talk in response to Nicole Prause’s many hateful and defamatory comments (see this section). Prause used the following two YouTube usernames to post her comments:

The following tweets are examples of Prause obsessively playing the misogyny card and tweeting her “everyone is a misogynist infographic”. Note: Prause has never provided a single verifiable example of her being a victim of personal attacks or misogyny (certainly not by the person’s she names). It’s all propaganda. Unfortunately many believe her falsehoods.

Prause looks for any opportunity to tweet her infographic:

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She has never provided a single documented incident of anything arising from FTND. on the other hand Prause has engaged in about 100 separate instances of defamation and harassment targeting FTND. See these sections for a whole lot more:

How did Taylor Kohut manage to achieve his anomalous results? His study framed egalitarianism as: (1) Support for abortion, (2) Feminist identification, (3) Women holding positions of power, (4) Belief that family life suffers when the woman has a full-time job., and oddly enough (5) Holding more negative attitudes toward the traditional family. Secular populations, which tend to be more liberal, have far higher rates of porn use than religious populations. By choosing these criteria and ignoring endless other variables, lead author Taylor Kohut knew he would end up with porn users scoring higher on his study’s carefully chosen criteria of what constitutes “egalitarianism.” Then he chose a title that spun it all.

The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

The goal of this review was to synthesize empirical investigations testing effects of media sexualization. The focus was on research published in peer-reviewed, English-language journals between 1995 and 2015. A total of 109 publications that contained 135 studies were reviewed. The findings provided consistent evidence that both laboratory exposure and regular, everyday exposure to this content are directly associated with a range of consequences, including higher levels of body dissatisfaction, greater self-objectification, greater support of sexist beliefs and of adversarial sexual beliefs, and greater tolerance of sexual violence toward women. Moreover, experimental exposure to this content leads both women and men to have a diminished view of women’s competence, morality, and humanity.

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More misogyny claims, never an actual example.

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Upset that she was called Miss one time, when she wanted was more info about Wilson’s dick

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Brings in her allies, Ley and Miller.

The perpetrators claim victim-hood.

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More of same:

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Appropriate phrase: “sex research & stalking” – but they don’t know that Prause is the cyber-stalker:

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More claims about “porn activists”, but never an actual example:

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Presenting her falsehoods about “anti-science attacks” at a conference

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Presenting same falsehoods at her alma mater – The Kinsey Institute

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More about her Kinsey talk.

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David Ley (Prause’s side-kick) supports her mythology:

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Opposition to her claims is motivated by misogyny:

Prause clearly states that anyone who believes that porn can be harmful or addictive is a misogynist. Every single person:

Again, dirty deeds by “activists”. But the deeds are never named and she never provides evidence for a single deed:

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Spreading her myths

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Prause ally spreads her lie that she had a restraining order on Gary Wilson. This nonsense is covered in many sections of this page.

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The preceding tweets represents the tip of the Prause iceberg of her faux victim-hood.

May 2014: Multiple sock puppets post information on YourBrainRebalanced.com that only Prause would know (many more examples)

The day the Max Planck study on porn users was published (suggesting that porn use may have measurable effects on the brain), four aliases including “touif” and “TrickyPaladin“ posted approximately 100 comments on YourBrainRebalanced.com. What’s left of their comments is here, as the troll deleted her comments within a few hours. Most of the touif and TrickyPaladin comments were either attacks on Wilson or meticulously detailed ‘defenses’ of Prause’s 2013 EEG study. Below are few examples caught by a YBR member’s cell phone where TrickyPaladin and touif make detailed assertions about Steele et al., 2013 that only a handful of people could produce (and only Prause would care about):

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I’ll ask, who (other than Prause herself) would know details of a complex EEG study well enough to attempt defense of it, or want to post 100 times on a porn recovery forum to defend it? (If you bothered to read the above comments, know that any and all such claims have been dismantled by this extensive critique, and six peer-reviewed papers: 1, 2, 3, 4, 5, 6.)

While Tricky (and other sock puppets) deleted most of her comments, she left a few describing a “yet to be published chapter by Prause” supposedly chronicling Gary Wilson’s evil deeds:

Who but Prause would know details of an unpublished chapter by Prause? The above comment is from May, 2014. The “upcoming” Prause chapter was in fact published 8 months later in this book – “New Views on Pornography: Sexuality, Politics, and the Law.“ Of course, Prause did not identify Wilson in the chapter, as her claims of “horrible things” are fabricated nonsense.

As mentioned, sock puppets posting Prause-like comments continue to this day on porn recovery sites such as reddit/pornfree and reddit/nofap. Right from the beginning Prause had an odd habit of frequently creating usernames from 2-4 capitalized words (i.e. GaryWilsonStalker). The following reddit usernames were all created the day the comments appeared on r/pornfree and r/nofap. While the usernames and comments are often deleted by the sock puppet, a few examples with content remain:

These same false assertions are made by no other Wilson critic and continue to this day in tweets and comments by Prause and by her many sockpuppets.

A few examples of Prause sockpuppets on Quora where Gary Wilson occasionally answered questions about porn addiction. All names only commented under Wilson’s answers. Note that Quora requires members to use their actual names. Mods ban trolls who use fake names (as they did with Prause’s fake names):

https://www.quora.com/profile/Gareth-Wilson-22/log

https://www.quora.com/profile/Andrew-Blivens/log

And these are just the ones we happen to see when visiting r/pornfree and r/nofap to gather recovery accounts. In addition, many more such usernames and comments appeared on YourBrainRebalanced.com, but were deleted by the moderators.

Prause makes it no secret that she vehemently opposes the concepts of sex and porn addiction. In the summer of 2014 Prause placed the following notice on her SPAN Lab website. You can read for yourself that Prause is encouraging all individuals being treated for sex addiction to report their therapists to the state board (it contains a handy hyperlink):

A month later Prause reminds us all again to report our local sex addiction therapist. It’s free and easy!

Prause doesn’t stop with tweets directed at a profession. She ups her game, falsely accusing psychotherapists of fraudulent therapy. Isn’t this rather reckless for a psychologist, especially given that (1) diagnoses of compulsive sexual behavior can be made using the World Health Organization’s ICD-10 and (2) Section F52.8 of the DSM itself recognizes the diagnostic validity of excessive sex drive as a valid, reimbursable disorder? In short, Prause is mistaken and behaving unethically.

I am open to chatting with you, but I should probably clarify two items.

First, I do believe, and have published, some negative effects of sex films. It is fair to say that I do not believe it is addicting. If it is useful to you to have a scientist who can talk about both the benefits and possible problems with sex films, I am probably best-suited to that type of role.

Second, I am not willing to be placed in opposition to Gary Wilson, Marnia Robinson, or Don Hilton. None of these individuals are scientists, and all have attacked me personally, making it unsafe for me to be put in a direct confrontation with them. For example, they claimed that I was secretly funded by pornography, falsified my data, and wrote me and my university chancellor many times trying to harass me at home and work. If you were considering these individuals, I would be happy to get you in touch with some actual scientists who support that sex films can lead to addiction. These individuals, in my opinion, would be scraping the bottom of the barrel for a film.

I realize this information may be in direct opposition to your desire to have free artistic reign, so I understand if I might not be useful to your film given this information. Regardless, best of luck with your project!

Nikky

Nicole Prause, Ph.D.

Associate Research Scientist

University of California, Los Angeles

www.span-lab.com

Prause is once again lying. As addressed below, Wilson never said that Prause had “falsified her data” or that she was “funded by pornography.” While Gary Wilson wrote UCLA chronicling Prause’s harassment and cyberbullying (see below), he never attempted to contact Prause directly at home or at work. (In reality, it is Prause who initiated all direct contact with Gary Wilson as documented in the first section.) Donald Hilton Jr. MD confirmed that he has never attempted to contact Nicole Prause or UCLA, nor did he say what Prause claims in the above email.

Key point: There is reason to believe that this behind-the-scenes defamation of Wilson and others is standard procedure for Prause. See further example relating to TIME magazine and Gabe Deem below. Note how Prause tries to control who is being interviewed by stating that she is not willing “to be placed in opposition to Gary Wilson or Don Hilton.”

January, 2015: “The Prause Chapter” described 9 months earlier by a YourBrainRebalanced.com troll is finally published

[To recap, a YourBrainRebalanced troll (TrickyPaladin) posted 50 comments or more on the same day the JAMA fMRI study on porn users was published (affirming that porn users’ brains show measurable changes correlating with time/years of use). Most of TrickyPaladin’s comments were either attacks on Wilson or meticulously detailed (attempted) defenses of Prause’s 2013 EEG study. While Tricky deleted most of her comments, she left a few saying a chapter in an upcoming book would detail horrible things done by Wilson.]

The book and chapter now arrive: “New Views on Pornography: Sexuality, Politics, and the Law.” The chapter in question (“The Science and Politics of Sex Addiction Research.”) is authored by Nicole Prause and Timothy Fong. It consists mostly of a discussion of the appropriate “model” for understanding compulsive pornography use. Only two paragraphs are devoted to Prause’s undocumented and unsupported claims of being harassed. The most outlandish claim is that “individuals mapped routes to the laboratory address.” In other words, Prause is claiming that Google maps told her when people were searching for her lab’s address. Of course Prause did not name Wilson or anyone else in her chapter.

Key point: Knowing the details of an unpublished chapter 9 months before it is published incriminates Prause as TrickyPaladin. As do the meticulously detailed comments defending Prause’s flawed 2013 EEG study.

“Some individuals repeatedly emailed her after we had requested contact to stop… resulting in a police report”

Both claims are aimed at Wilson, and both are false.

[As explained above, here’s the reality behind each claim:

1) “Photos stolen”

A single picture, selected by Prause herself, from (what appeared to be) a UCLA lab website was used in an article about a study published and promoted by UCLA & Nicole Prause. The “porn site” was YBOP, a preposterous claim, as it is a porn recovery support website without x-rated content.

2) “Individuals repeatedly emailing me….police report filed”

Police Report: Wilson has never been contacted by the police. A call to the Los Angeles police department and UCLA campus police revealed no such report in their system.

Email Claim: It was Prause who initiated all contact with Wilson after he wrote a Psychology Today blog post. Prause’s harassing emails contained threats and false statements, and it was Prause who continued to harass Wilson. See above.]

In the chapter Prause also stated:

“Noticeably absent from these attacks are published critiques from any scientist.”

Contrary to Prause’s claim 15 peer-reviewed critiques of her studies have been published:

As for Prause’s research at UCLA never stopping, it’s important to note that UCLA chose not to renew Prause’s employment contract (although she continued to claim publicly that she was still a UCLA researcher employed at the medical school). Prause hasn’t been employed by UCLA or any other university since late 2014 or early 2015.

David Ley and Nicole Prause team up again. This time falsely accusing sex addiction therapists of practicing reparative therapy or conversion therapy. It started with Ley publishing “Homosexuality is Not an Addiction” which not so subtly, falsely accused members of IITAP and SASH of trying to turn their gay clients straight. (In response to complaints, Ley was later forced to alter the post and Psychology Today eventually deleted the comments.)

Prause tweeted the Ley post:

Prause was the first to comment, falsely accusing IITAP of harboring reparative therapists, and claiming to have emailed IITAP the names of the accused. While Prause’s comments were later deleted, she commented a few weeks later groundlessly accusing (gay!!) therapist Michael J. Salas of practicing reparative therapy as follows:

Having received no response to her groundless accusations, Prause “outed” Salas as a reparative therapist. She took a sentence out of context, hoping no one would actually visit his website. On his website, however, readers discover that Salas specializes in therapy for the Gay/Lesbian/Bisexual/Transgender community. He is a member the “Texas Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling”, Salas also states:

“For clients who are gay, lesbian, or bisexual, I provide LGBT Affirming Therapy. There is no such thing as changing someone’s sexual orientation”

On submitting specific names and concerns, CSAT did not respond. After pressed with three queries and by other professionals they responded that te allegations were false. They provided no investigative process. For this writer to inquire would change nothing and make him yet another target of that community. I would discourage anyone from tangling with a group with no intention of addressing its problems.

I am happy to share the emails with you privately. They were disgusting to me as a licensed psychologist too.

Actually, any investigation shows her claims were completely false. Click on the link to Prause’s comment and you see no replies. That’s because Joe Kort deleted all comments challenging Prause, leaving her fabrications unchallenged. We have reproduced those (now) deleted comments below. The first 2 comments have CSAT Michelle Saffier asking Prause for data, and Prause responding:

The 3 Prause “complaints” were nothing more than cyberstalking. Michelle Saffier received no data or emails from Prause. The next comment challenging Prause was posted by anonymous:

Gabe Deem recovered from severe porn-induced ED by quitting internet porn use. He now runs Reboot Nation and occasionally appears on TV and radio to discuss his and other men’s experiences with porn-induced sexual dysfunctions. In May, 2015 Gabe published a detailed critique of the Nicole Prause and Jim Pfaus paper, “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction.” Everything in Gabe’s page is accurate, documented, and unassailable. Gabe’s critique aligns with a Letter to the Editor of the journal where the paper appeared, by Richard A. Isenberg MD, though it provides more details about the Prause paper’s glaring discrepancies and unsupported statements.

A long debate ensued when user “FapSlap” posted the Prause & Pfaus paper on reddit/nofap. Prause-apologist “FapSlap” (who appears to be a researcher) eventually claimed to contact Nicole Prause looking for ammunition to defend the Prause paper. Here’s FapSlap’s comment confirming not only his/her email exchanges with Prause, but a future response to her critics:

Of course you will probably say ‘fake is fake.’ But believe me it’s not. Out of respect I am not posting the conversation. You will have proof soon enough for the journal, trust me And I will be quite happy to see your ‘bullet in the barrel’ critique be thrown out the window.

Actually, he did just write me and he is correct. We collected the full IIEF in many studies in which we do not ultimately publish the data. Sometimes we choose not to, sometimes reviewers tell us to remove them because they are not relevant.

We are publishing a follow-up letter in the journal to show all the counts remain correct. All the analyses remain correct. The conclusions stand.

I will not be responding to any follow-up posts. I posted here only out of compassion, because you are lying to this poor person. Wait for the letter. It is to appear in April and will dispel all the myths RebootNation is propagating to the poor people they are using to fund their speaking travel and fees and false “counselor” titles.

The promised response did not address any of Isenberg’s concerns (as pointed out subsequently by Deem) and merely added new unsupported claims and untrue statements. Prause also falsely states that Gabe (RebootNation) is lying and that he makes money from RebootNation and speaking fees. While none of this is true, these same exact claims soon appear again via “PornHelps” and several r/pornfree sock puppet user names.

On March 31, 2016, the TIME cover story featuring Gabe, and other men who had recovered from porn-induced sexual problems, was published. On April 1 the following post by TruthWithOut appeared on reddit/pornfree: Gabe Deem admits profiting of NoFAP Reboot Nation. The original post, the “TruthWithOut” username, and a few of her comments, were later deleted (though most of her comments remained). The original post, claiming TIME had “outed” the nefarious Deem:

You can read TruthWithOut’s remaining comments and see the same false claims repeated over and over: 1) Gabe is lying about everything, 2) he never had ED, 3) he makes money from both RebootNation and speaking fees, and, 4) he’s unemployed. All untrue. One example:

And I’m waiting on that evidence Gabe. ANY shred of evidence that you are not just lying. No one has seen anything validating any part of your story. Not your supposed girlfriend, no doctor, no one. You could easily provide it, but you haven’t.

You are just taking trips and money from guys you stir into a panic with your made up tales.

The facts? The TIME Magazine article incorrectly stated that Gabe Deem made money through speaking fees. While this is not true (and was later publicly corrected by TIME), TruthWithOut used this journalistic error to launch an attack, claiming a series of lies. A few days later Deem tweeted the correction from the print version of TIME Magazine. (TIME formally acknowledged that it had erred in saying that Deem makes money from his activities connected with RebootNation.) End of story. Nonetheless, several other Prause sock puppets posted similar allegations (that “Deem lied about everything“) on Reddit/pornfree and elsewhere. A few examples:

Another Prause sockpuppet with her usual 3 capitalized words, harassing Gabe Deem on reddit/pornfree (https://www.reddit.com/user/TruthWithOut) – with the exact same calims of Gabe faking his porn-induced ED. Prause starts with this post, and is followed by almost 20 comments:

Thing is, Gabe makes no money off his porn-recovery forum and had never taken any money for speaking fees. Prause/TruthWithOut just keep ranting:

Look everybody! It’s Gabe Deem back again reposting anti-sex rants again and puppeting his own upvoted post! You might remember him from the Reason post where he was shredded for posting this anti-science message with links back to his own website. He has no college degree, no job, and is paid (see Time article) for speaking about his erectile problems he claims (with no doctors’ evidence) were “due” to porn.

I know I know, you are going to repost a long list of links hoping no one actually follows them and knows the truth, but this is it. And I’m not engaging further. Hopefully the folks form the previous time you did this will find your posts again Gabe Deem.

PornHelps references the TIME article, making the same false claims as the many Reddit sock puppets. This is no coincidence. Below you will see that Prause as Prause (i.e., using her own name) called TIME journalist Luscombe and NoFap.com founder Alexander Rhodes ‘liars’ and ‘fakers’.

Immediately after Prause’s Twitter account was suspended, this defamatory post appeared on reddit/pornfree, attacking Gary Wilson, Gabe Deem, the author of the above paper, and others. Three newly created usernames commented most. Two usernames were later deleted, but EvidenceForYou remained. Several comments suggest Nicole Prause is the author of these comments – most notably by stating that lawyers are now involved, or that Wilson is about to be sued:

Link – Gary Wilson, they have your IP and all the records courtesy of a subpoena. We’re not chasing these new lies too, just going to stop the one’s you have already been telling. Prepare to file for bankruptcy again.

Link – When they cannot fight the science, they fight the person. They fail, so they spread false rumors that are currently the subject of a lawsuit. This proves it.

A week or two later (October 15, 2015) Gary Wilson received a ‘cease and desist’ letter from a lawyer representing Nicole Prause. It stated that Gary Wilson had made four false and misleading statements about Prause. Of course, all four were untrue (such as Wilson saying that “Prause starred in porn films”….unbelievable!). Wilson responded with a letter stating all were false, and asked for proof of these claims (reproduced later on this page). There was no response by the lawyer or by Prause. Just another example of Prause’s continued pattern of harassment while simultaneously playing the victim.

Two individuals, whose specialty overlapped the erroneous article [Prause and Ley], attacked the article for its political misstatement, and by extension, Cureus’ journalistic integrity for missing this error during our pre-publication review process.

I immediately invited these critics to set the record straight via our liberal comment and scoring processes, but in a series of personal (and necessarily confidential) emails, the critics refused, insisting on remaining anonymous. Over the next several days they recruited a chorus of similarly-minded colleagues who insisted that the article in question represented serious scientific misconduct and demanded it be retracted… period!

… In parallel, I stumbled upon the existence of a listserv community of likeminded researchers including the two critics, whose major modus operandi is to fiercely act en-mass, hyena-like, oftentimes via social media, when certain partisan political issues arise, such as the article Cureus had unwittingly published.

If ever I witnessed intellectual fascism, this was it; the only thing missing was a goose-stepping mustached man….

By the way, we know he is talking about Ley and Prause because 1) both Ley and Prause engaged in a Twitter storm against Adler prior to his post appearing (we have tweets by Adler, but Prause’s tweets are unavailable because her @NicolePrause account was eventually permanently suspended due to her misconduct). 2) David Ley posted all about this on a sexology listserve.

As part of the storm Adler wrote about, former porn star and current radio show host Melissa Hill, tweeted that Dr. Adlers son “managed to get @NicolePrause PhD’s account suspended!”:

The above is entirely false as Prause’s Twitter account was permanently suspended for posting the personal information of one of the authors of this paper “Neuroscience of Internet Pornography Addiction: A Review and Update” (2015). Trip Adler had nothing to do with it, as Prause caused it herself. The logical conclusion is that Prause fed Melissa Hill this false story. It seems they are friends. Prause has appeared on Melissa Hill’s radio show several times, and Prause re-tweeted a photo of her and Hill together on the red carpet of the Adult Video awards. A few days later, the Free Speech Coalition (the lobbying organization for the porn industry) offered Prause assistance, suggesting she contact Diane, the CEO of the Free Speech Coalition (FSC).

Question: Why is the porn industry offering high-level assistance to Nicole Prause? Whatever the reason, Melissa Hill and the FSC join up to harass Adler’s son (Trip Adler) – all because Prause told Hill and the FSC her fabricated accusation that Trip Adler got her thrown off twitter:

The promised story has yet to appear, and Prause has given no formal (or truthful) explanation for her permanent Twitter suspension. Three years later, Prause is still dishonestly blaming Adler’s son for the permanent suspension of her first Twitter account:

Prause has never provided a single iota of evidence for her tall tale that the CEO of Twitter personally deleted her first twitter account. The truth about Prause’s permanent suspension is right here.

OTHERS – March, 2016: Prause (falsely) tells TIME Magazine that Gabe Deem impersonated a doctor to write a formal critique of her study (letter to the editor) in an academic journal (and the letter was traced to Gabe’s computer).

On March 31, 2016, the TIME cover story (“Porn and the Threat to Virility”), by Belinda Luscombe, featuring Gabe Deem, Nicole Prause and many others, was published. It was a year in the making and TIME had the author and other TIME employees (fact checkers) follow-up on claims made by each person interviewed. In the process, TIME fact-checkers presented Gabe Deem with a final set of questions for him to confirm or to deny.

One fact to confirm or to deny was an allegation put forth by Nicole Prause. Prause had told TIME that Gabe Deem had impersonated a medical doctor to write the letter to the editor of an academic journal (described above) critiquing a paper the journal had published by Prause & Pfaus. Below are snapshots from TIME‘s email to Gabe. They include the email intro and the allegation from Prause, but omit other, unrelated questions:

The Intro to the email:

The last of many questions in the email:

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Richard A. Isenberg, a medical doctor and author of multiple academic papers, specializing in Uro-Gynecology, is the one who wrote the critique (A letter to the editor), which was published in “Sexual Medicine Open Access,” the same journal that published Nicole Prause and Jim Pfaus’s paper, “Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction.” Since Gabe also wrote a critique of the same paper, Prause appears to be accusing Gabe of writing Isenberg’s critique as well! More astonishing still, Prause claimed that UCLA had traced the Isenberg critique to Gabe Deem’s computer. Of course, no evidence was supplied to back up any of these unbelievable assertions.

How likely is it that UCLA would hack the computers of men recovering from porn-induced ED? The thing that makes Prause’s claim about UCLA particularly unstable is that Isenberg’s Letter to the Editor was published 6 months after UCLA did not renew Prause’s employment contract – and yet she claims UCLA was engaging in cyber-espionage on her behalf! All this reveals just how far Prause is willing to go. And unlike much of her unscrupulous behavior this attempt at defamation is documented by a third party (TIME magazine’s staff).

OTHERS – June, 2016: Prause and her sock puppet PornHelps claim respected neuroscientists are members of “anti-porn groups” and “their science is bad”

As usual her claims are preposterous. First, it’s an excellent study, now formally published despite all the incomprehensible resistance. Second, its authors received first prize for this very research at the European Society for Sexual Medicine conference in 2016. Third, the authors have no affiliation with Prause’s imaginary “anti-porn groups” (which Prause never names).

As Matuesz Gola explained to “PornHelps” in the comments section, BioRxiv (where Prause found it) exists for pre-publication papers, and functions to elicit feedback from researchers in order to improve papers. It should be noted that the “pornhelps” comments and Prause’s tweet appeared at the same time. Do the following pornhelps comments sound like porn industry shill or a researcher:

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It’s clear that Prause as herself, and as pornhelps, is disturbed by any neurological study lending scientific support to the porn addiction model (all do). But there’s more to this story. Matuesz Gola also published a formal critique of Prause et al., 2015, which explained that Prause’s findings align with two established addiction models (4 reviews of the literature agree with Gola) – contradicting Prause’s claim (that she had disproved (or, as she likes to say publicly, “falsified”) the addiction model with her single paper).

Update – Prause confirms what we already knew – that she is pornhelps. @pornhelps later states “I have 15 years studying as neuroscientist”:

Prause, a Kinsey grad, calls herself a neuroscientist, and appears to have started college about 15 years before this tweet. More on @pornhelps below. (Update – @pornhelps later deleted its twitter account and website when it became apparent to others that Prause often tweeted with this account, commented as pornhelps, and helped with the website)

How ethical is it for psychologists to personally attack individuals trying to remove porn from their lives and recover? Ley has a history of attacking Rhodes and NoFap, and harassing young men trying to quit porn. Prause, a psychologist, tweets again, making fun of Rhodes’ appearance:

Rhodes eventually responded, and Prause accused Alexander of faking his porn-induced sexual dysfunction:

Prause did not name Wilson, so she may be off the hook, legally speaking. All claims are false as Wilson has 1) never been contacted by the police, 2) never threatened her lab, 3) is not under any “no-contact order” except threats from Prause herself after Prause harassed him. This tweet once again incriminates Prause as the individual responsible for the many defamatory comments described in the first section. Prause ended it all as she usually does: citing no evidence and tweeting Rhodes “I sent you documentation. Do not contact me again.” That’s Nicole Prause’s MO: Initiate a personal attack, follow it up with lies, then end it all by playing the victim. By the way, Prause sent no such documentation. Yet another lie. Others were watching the Twitter storm, which led to an article detailing it, and more Prause tweets attacking yet another person (below). Meanwhile, consider the fact that it is a violation of APA (American Psychological Association) principles for psychologists to attack those trying to recover.

Over the next few months Prause takes every opportunity to belittle and attack Alexander, NoFap.com, and men recovering from porn addiction:

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Prause went so far as to falsely accuse another “quora” user of being Alexander Rhodes and thus holding a “trademark”.

As explained here, Prause was eventually banned from Quora for harassment of Gary Wilson. In this out of the blues May, 2018 tweet attacking Nofap, Prause cited an opinion piece in the journal “Sexualities” falsely stating that the article had “shown by science to denigrate women”.

The day after the above Alexander Rhodes/Nicole Prause dustup, @PornHelpdotorg published a blog post detailing the events: “Reflections on a Twitter Skirmish,” and tweeted it to Rhodes, Prause, and David Ley. This set off another Twitter conversation, which you can read in entirety here (prause has delted all herPrause’s first response once again claims documentation:

Once again Prause performs her usual dance: Start with false unsupported claims. When asked to support the claims, she cannot. Finally, Prause resorts to legal threats, instead of the requested documentation or examples. As always end with “do not contact me”.

Evidence points to Prause sharing the @pornhelps twitter account and using the PornHelps disqus username. As described above, Prause published (then deleted) a bizarre tweet about this Matuesz Gola study. PornHelps simultaneously commented under the Gola study using the jargon of a researcher. In addition, the following @pornhelps tweets arise from Los Angeles, where Prause lives. (Update – @pornhelps later deleted their twitter account and website as it became apparent that Prause often tweeted with this account)

This was followed by @pornhelps calling both Alexander and Belinda liars. @NicoleRPrause eventually chimed in to call TIME journalist Luscombe a liar (more in the next section). The back and forth contains too many tweets to post here, but most can be found in these threads: Thread 1, Thread 2, Thread 3. Below is a sampling of @pornhelps’s unstable-sounding tweets falsely claiming that Alexander faked his story of porn-induced sexual problems:

@luscombeland @nytimes “Brave”? Faking a problem to promote his business? You failed to verify any part of his story

@GoodGuypervert @luscombeland exaggerating makes them money, esp in his case. These guys are mostly unemployed, no college…got $$$ somehow

In the Ley interview Prause claims to have unpublished data falsifying any connection between “porn addiction” and penile injures (Prause also said she will never publish the data). It’s important to know that both Prause and Pornhelps had been saying that Alexander lied about his masturbation-induced penile injury and porn-induced sexual problems.

Is it any coincidence that 3 days after multiple @pornhelps tweets called Alexander a liar, Ley and Prause publish a Psychology Today blog post directed at one of Alexander’s complaints (that he injured his penis from excessive masturbation)? Interestingly, their own data apparently showed that a fifth of those surveyed had experienced similar injuries. But again, Prause refuses to publish the data, while claiming her data somehow (inexplicably) prove that Alexander must be a liar. In any case Prause’s blog claims remain unsupported as she did not assess “porn addiction” or compulsive porn use in her subjects (read the comments section of Ley’s post).

UPDATE: December 12, 2016. Prause falsely claims that @Nofap drove gay teen to suicidal feelings (also calls Alexander Rhodes an “anti-porn profiteer”). Prause’s tweet linked to a radio show about Jehovah Witnesses and sex abuse, which contained a segment about a 14-year old gay teen whose mom found his stash of porn magazines. Since being gay is against JW doctrine, the church insisted the gay teen no longer masturbate to images of men. The gay teen was driven to thoughts of suicide because he was a homosexual stuck in the JW facing the very real prospect of being tossed out of the church and shunned by his family and friends. The radio segment did not mention NoFap. Here’s Prause’s tweet (notice that only David Ley liked it):

Prause’s twisted and libelous tweet attempting to smear NoFap in connection with an entirely unrelated event demonstrates just how far she is willing to stretch the truth in pursuit of her agenda. The NoFapTeam responded with 3 tweets:

Not so coincidentally, a rambling hit piece about NoFap, featuring Nicole Prause, was published a few days later by Medical Daily. Of course Prause tweeted it, saying “claims busted by scientists.” By “scientists” Prause means herself. This goes to show that Prause has many contacts in the media, and uses them to her advantage. Prause also called NoFap “woo woo and cult-like.” Medical Daily author Lizette Borreli went so far as to label NoFap an “anti-sex group.” Anyone who has visited Nofap knows that nothing could be further from the truth. Many experiment with NoFap to regain their sexual function. NoFap decided to set the record straight with a few tweets of its own (1, 2, 3, 4), including this one:

Once again, Prause teams up with David Ley to defame Alexander Rhodes, Nofap (along with Gary Wilson’s website and RebootNation). Revealing her long-time obsession with over Rhodes, Prause tweets 4 screenshots form the last 3 years:

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On Quora, Prause accuses a commenter of being Alexander Rhodes (it wasn’t, of course):

It sure seems that Prause tweets more about NoFap and Alexander Rhodes than she does about her own research. Prause claims to be licensed psychologist. What ethical psychologist would go out of the way to call a young man recovering from compulsive porn use a liar, especially without evidence? Ethics violation? Violation of APA principles?

Luscombe has been with TIME Magazine since 1995, becoming a senior editor in 1999. (See her Wikipedia page and her TIME page.) Luscombe spent a year investigating porn-induced sexual problems in young men, which resulted in the March, 31, 2016 TIME cover story “Porn and the Threat to Virility.” Both Prause and Ley have attacked the TIME article, even though both were featured in it and quoted (minimally).

Unfortunately for the public, usually Prause and Ley are the only “experts” featured in most mainstream porn-addiction articles, while the true addiction neuroscientists and their work are not even acknowledged to exist. Not this time. Two world renowned neuroscientists, who have published fMRI studies on porn users, were interviewed for the TIME article. So was a urologist, as well as several young men who have recovered from porn-induced erectile dysfunction. Put simply, the TIME article was more carefully researched than any other article on this subject, and its content reflected both reality and the (then) current state of the science. Since then, even more support for the possible link between internet porn use and sexual dysfunctions has come out in the peer-reviewed literature.

In response to Belinda’s earlier tweet (pictured above) about working the story for a year, we have @pornhelps, tweeting the following:

Pornhelps is psychic: she knows “for fact” how long Belinda worked on the story. Ten minutes later Prause tweets claiming Belinda misquoted her and “lied about her sources”:

As always, Prause provides no examples and no documentation. Not being tagged, how did Prause know about Belinda’s tweet or @pornhelp’s reply? Maybe Prause is psychic too?

Reality Check: It is Prause and @Pornhelps who are lying. As many can verify, Luscombe contacted Gary Wilson, Gabe Deem, Alexander Rhodes, Noah Church, David Ley, and others, during the year before the TIME cover story was published. In addition, Luscombe and several TIME Magazine fact-checkers contacted each individual several times to corroborate each interviewee’s claims.

We know that Wilson’s former employers were contacted, as were the girlfriends of the men with porn-induced sexual problems. Interviewees were also asked to deny or confirm claims given to TIME by David Ley and Nicole Prause. This was done in writing, often 2-3 times for each claim.

For example, Nicole Prause falsely claimed to TIME magazine that Gabe Deem masqueraded as a medical doctor to write this peer-reviewed critique of Prause & Pfaus 2015 (in fact written by a medical doctor/researcher). Even more astonishingly, Prause told TIME that UCLA had traced the “Richard A. Isenberg MD” critique (Letter to the Editor) to the young man’s computer. This outlandish attempt to defame Deem is all documented above.

Despite claiming that she is “not a science writer,” she continues to try to cover scientific topics. This often results in required retractions by the scientists then forced to clean up her poor writing.

The above comment was reversed the next day by another Wikipedia editor. Without checking this user’s other comments, it’s evident that this was likely done by Nicole Prause. Moreover, an investigation of this user’s only other 3 Wikipedia edits erases all doubt that this is Prause’s handiwork:

Only Nicole Prause would have made theses edits, especially the last 3:

“Largest neuro study mysteriously left off previous edits.” This is referring to Prause et al., 2015, which is the study that only Prause boasts (inaccurately) is the largest neurological study on porn addicts. No one else calls her EEG study the “largest study” because: 1) Many of Prause’s subjects were not really porn addicts; 2) two other neurological studies assessed greater numbers of subjects.

“Removing pseudoscience by Gary Wilson.” Who else would (falsely) accuse Gary Wilson in a Wikipedia edit? In the section below we reveal other Prause Wikipedia sock puppets who attack Gary Wilson, including a sock puppet with the user name “NotGaryWilson.”

On September 15th, 2016 Nicole Prause posted a fake press release on the website PROLOG. Prause’s “press release” attacked and libeled several individuals including Gary Wilson, Donald Hilton MD, Utah state senator Todd Weiler, and Dr. Todd Love. This is what remains of the press release, as ProLog removed the content 2 days later because it violated their policies. Not to be denied, Prause placed the press release’s content on her AmazonAWS account. Here we examine her comments about UCLA researcher and former colleague Rory Reid PhD. Excerpt from Prause’s rant:

“Psychologist” and “LCSW” are both regulated titles licensed with the state of California that Rory Reid was using to advertise his services to patients but did not actually possess. Rory Reid also has falsely described that he attended and is on faculty at Harvard University and is an “assistant professor” at UCLA. Reid was never faculty at Harvard University and is an adjunct, not tenure track faculty, at UCLA. Reid is listed as a full-time employee of the State of California’s Office of Problem Gambling at UCLA, so it is unclear how Reid would be able to study sex films and contact politicians about sex films without violating his state contract.

A little background on Rory Reid and former UCLA researcher Nicole Prause is useful here. Rory Reid has been a research psychologist at the David Geffen School of Medicine, UCLA since before Nicole Prause’s brief stint at UCLA began in 2013. Reid’s research areas are hypersexuality and gambling addiction.

Reid, like Prause, has often argued against the existence of “sex addiction.” Reid stated in a 2013 article that his office was right next door to Prause’s at UCLA. In 2013 Nicole Prause listed Rory Reid as a member of her “SPAN Lab.” As stated, Prause’s UCLA contract was not renewed while Reid remains a researcher at UCLA. Whatever he did to displease her, Prause is now attacking a former colleague publicly and brutally.

But there’s more to the story. Months earlier, in December 5th, 2014 several comments mirroring Prause’s “press release” (urging readers to report Rory Reid to California authorities) were posted on the porn recovery site YourBrainRebalanced by a brand new member. As we saw above, Prause made a habit of commenting on YBR using various aliases. The first of these comments, by TellTheTruth, contained 2 links. One link went to a PDF on Scribd with supposed evidence supporting TellTheTruth’s claims (Prause regularly use aliases with 2-4 capitalized words as usernames).

Two more comments by TellTheTruth that mirror Nicole Prause’s “press release” (now) published nearly 2 years later.

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The TellTheTruth comments and PDF from December, 2014 along with the Prause’s press release incriminate Nicole Prause as cyberstalking Rory Reid at about the time she was leaving UCLA. Key point: The documents that Prause placed on her AmazonAWS account about Reid are the same documents that TellTheTruth placed on YourBrainRebalanced 2 years earlier. Note the same “2013 copyright State of California” for Prause’s current screenshot and TellTheTruth’s 2-year old screenshot:

Prause’s current document: https://s3-us-west-1.amazonaws.com/weilerdefamation/NoLicenseInCalifornia.png (note the URL in this screenshot & the 2013 copyright)

TellTheTruth’s document she posted 2 years earlier on the porn recovery forum YourBrainRebalanced. Notice the 2013 copyright and how TellThe Truth pasted Reid’s picture into her PDF:

Here’s why we know TellTheTruth was Nicole Prause: The current license search has a 2016 copyright notice! Prause was harassing and cyberbullying her UCLA colleague Rory Reid in December, 2014 (about the time she was leaving UCLA), and she’s still using the same screen shots to do it.

Here’s another another example of duplicate documents by Prause-2016 and TellTheTruth-2014. Prause’s current AmazonAWS document – https://s3-us-west-1.amazonaws.com/weilerdefamation/BevHillsClinicalPractice_ClaimsLCSW.png

Incidentally, it looks like Nicole Prause “stole” Rory Reid’s picture and placed on a website without his permission. Should he file a police report? And here’s TellTheTruth’s document from December, 2014. You can see from the URL stamp and heading that this was a PDF on SCRIBD:

Same documents, same claims, same spinning of the truth by both Prause and TellTheTruth. Here’s the Key point: Rory Reid is still a researcher at UCLA while Prause’s contract at UCLA was not renewed.

One has to ask why UCLA would willingly part with an up-and-coming researcher able to (1) debunk entire fields of science with a single study (in this case, the field of porn addiction research), and (2) persuade the media she has done so. Things are not always what they seem.

Back to the September 15th, 2016 fake press release Nicole Prause posted on the website PROLOG. Prause’s “press release” also attacked and libeled several individuals including Gary Wilson, Donald Hilton MD, Utah state senator Todd Weiler, and Dr. Todd Love. Again, this is what remains of the press release, as ProLog removed the content 2 days later because it violated their policies. Not to be denied, Prause placed the press release’s content on her AmazonAWS account (Amazon refuses to arbitrate content disputes). Since September 15, Prause has tweeted dozens of times about her document. Here we examine Prause’s comments about Gary Wilson.

Prause said: Dr. Prause had to file a police report and close and hide her UCLA laboratory under threat from this blogger and now requires physical protection at all her public talks from him. He has since been spotted in Los Angeles near the scientist’s home and LAPD threat management has been alerted.

Closed her Lab? Armed guards? Spotted near her home? All this because YBOP critiqued her 2013 EEG study? All these claims are untrue, and the claim that “Wilson has been spotted seen near the scientist’s home” is also fiction. Wilson hasn’t been to LA in years. A call to the Los Angeles police and the UCLA campus police revealed no police report about Wilson in either system. That is the only fact here.

Prause said: He wrote the UCLA chancellor over a dozen times claiming Prause had faked her data, faked her title, and more, all of which UCLA refuted.

False. Wilson wrote (or copied) the chancellor 3 times in late 2013 and early 2014 to complain about Prause’s ongoing harassment. The first letter informed UCLA about Prause’s multiple instances of harassment, frivolous legal threats and libel targeting Wilson and two others. This letter also documented Prause’s intimidation of Psychology Today editors (who acquiesced and removed Wilson’s critique and a critique by two other Psychology Today bloggers (both experts)). In one paragraph Wilson described how Prause misrepresented the finding of Steele et al., 2013 to the press. Seven peer-reviewed papers have since supported Wilson’s assertion (1, 2, 3, 4, 5, 6, 7.) Nowhere did Wilson say that Prause had “faked her data” or “faked her title.” Both Wilson and UCLA possess the original letters. Their content proves that Prause is libeling Wilson.

Wilson sent a second letter to UCLA (December 2, 2013) to complain about Prause placing a document libeling Wilson on the SPAN lab website (as described above). It was assumed that UCLA controlled the content as each SPAN Lab page contained the following:

Reproduced below are the first several paragraphs of Wilson’s letter to UCLA Chancellor Block:

Two weeks later a letter was sent to Vice Dean Jonathan R. Hiatt to inform him that Prause’s libelous PDF remained. Shortly thereafter the PDF was removed, although no official response was received until March, 2014. The Vice Dean informed Wilson that the SPAN Lab website was Prause’s own site, and not a UCLA website at all(!). Reproduced below is a portion of UCLA’s response to Gary Wilson’s letter:

So Wilson did not “write the UCLA chancellor over a dozen times.” This can be confirmed by UCLA. We must state again that Prause not only personally attacked Wilson, but attacked UCLA colleague Rory Reid PhD (see above section). UCLA did not renew Prause’s contract.

Prause said: He also broke into her private online account to stalk her after receiving a no-contact order. He stole her personal photos from that account, posted them to his porn website, then migrated them to try to evade DMCA take downs until his ISP threatened to shutter his website.

Addendum: Prause is now claiming in an AmazonAWS PDF that Wilson migrated the picture of Prause (and the associated article) to other servers. This is false. The picture of Prause accompanied a single critique that appeared on two separate websites, PornStudySkeptics and YourBrainOnPorn.com. These two identical articles have remained on those two websites since July, 2013: Article 1, Article 2. In her PDF Prause also claims that Wilson’s ISP told him that they “would close his website if he did it a fourth time”. This did not occur.

Prause said: Her name appears over 1,350 times on one website alone of an obsessed blogger.

This claim may actually be true. The website Prause is referring to is this one: YourBrainOnPorn.com. Approximately 700 of the 1,350 mentions are on this page alone. Why would YourBrainOnPorn.com contain an alleged additional 650 instances of “Prause”? YBOP contains about 10,000 pages, and it’s a clearinghouse for nearly everything associated with Internet porn use and its effects on the user. Nicole Prause has published multiple studies about porn use and hypersexuality, and by her own admission, is a professional debunker of porn addiction and porn-induced sexual problems.

A Google search for “Nicole Prause” + pornography returns about 11,000 pages. She’s quoted in hundreds of journalistic articles about porn use and porn addiction. She has published several papers related to pornography use. She’s on TV, radio, podcasts, and YouTube channels claiming to have debunked porn addiction with a single (heavily criticized) study. So Prause’s name inevitably shows up a lot on a site functioning as a clearinghouse for research and news associated with Internet porn’s effects.

Not only are Prause’s studies on YBOP, so are hundreds of other studies, many of which cite Prause in their reference sections. YBOP also has published very long critiques of six Prause papers. YBOP contains at least 12 peer-reviewed critiques of Prause’s studies. YBOP contains at least a dozen lay critiques of Prause’s work. YBOP contains many journalistic articles that quote Nicole Prause, and YBOP often responds to Prause’s claims in these articles. YBOP also debunks many of the talking points put forth by Prause and her close ally David Ley. Finally, YBOP members comment here asking about Prause’s studies or her claims in the media. However, YBOP also critiques other questionable research on porn and related subjects. These critiques are not personal, but rather substantive.

Prause plays the misogyny card

Over the last few years, Dr. Prause appears to have taken great pains to position herself as a “woman being subjected to misogynistic oppression when she tells truth to power.” She frequently tweets this infographic that she apparently also shares at her public lectures, suggesting she is being victimized “as a woman scientist,” and painting herself as a trailblazer forging ahead to prove porn’s harmlessness despite prejudiced attacks. She has even been known to tweet combinations of misogyny claims and claims that (legitimate, peer-reviewed) science with which she disagrees is “fake.” Any suggestion that Wilson, Deem or Rhodes are motivated by misogyny is fabricated, as their objections have nothing to do with Dr. Prause as a person or as a woman, and only to do with her untrue statements and inadequately supported claims about her research.

As for the Infographic, Prause’s only evidence of misogyny is that Wilson supposedly once wrote “Miss Prause” and once incorrectly spelled her first name as “nicki.” That’s it. Neither of these examples are on YourBrainOnPorn.com, and Prause provides no documentation as to where either supposedly appear. Misspellings/autocorrects occur in the digital age.

The info-graphic also claims that Alexander Rhodes is sexist because he defended Wilson against Prause’s libelous claims that “Wilson was recently seen outside Prause’s residence.” When did the refutation of lies become misogyny?

If YBOP is truly sexist why are the majority of the authors we critique men? This page lists the studies and papers YBOP has critiqued.

The total number of authors listed on all the papers: 56

Male authors: 42

Female authors: 14

Once again, facts debunk propaganda.

Finally, no one named on this page – whom Prause has accused of sexism and misogyny – endorses, or encourages, either. Speak with them and you will discover that the very opposite is true. All support the respectful treatment of women. Their issue with Prause is with her tactics and her unsupported claims about her research, not with her as a woman or a woman scientist.

Others – Prause falsely accuses Donald Hilton Jr., MD

Curious about Prause’s claim that Don Hilton, MD, “called her a child molester,” we contacted Dr. Hilton. Here is his response:

With regard to Prause’s claim, the facts are presented here. I did not call her a child molester.

About 6 or 7 years ago I spoke in 3 Idaho cities in one day for a group called Citizens for Decency. I spoke on evidence supporting an addictive model related to problematic porn use, which was mainly molecular biology at that point. This model has since been substantiated by structural and functional MRI studies.

At the end of my talk a young woman came up and basically said that she did not think there was any evidence supporting the addiction model. I only learned later that it was Nicole Prause, who was then employed in Idaho. Next, she said she had trained at the Kinsey Institute, implying that she was an expert on sexuality.

I asked her if she supported the research and methodology of the namesake of her institution, Alfred Kinsey. I explained to her that Kinsey had collaborated with pedophiles, and trained and instructed them to time with stopwatches how long it took children they molested to reach orgasm. I asked her if she supported Kinsey and his methodology. At that point she became hostile.

Her claim that I said she was a child molester is untrue; I didn’t know her, her name, or anything about her other than that she admired Kinsey. My point was that the person she considered her philosophical mentor had knowingly collaborated with child molesters. This is perfectly true. Attached is attached a copy of Table 34 from the Kinsey book on male sexuality published in 1948 [reproduced below]. The youngest child is 5 months old, and is described as having 3 orgasms. Note that most sessions are timed.

Incidentally, Paul Gebhard (coauthor of Kinsey’s female sexuality book published a few years after the male book), was interviewed by J.Gordon Muir years later. This is an excerpt from the interview:

Muir: “So, do pedophiles normally go around with stopwatches?”

Gebhard: “Ah, they do if we tell them we’re interested in it!”

Kinsey, Pomeroy (an early president of AASECT), Gebhard, and others worked with 2 child molesters, Rex King and a Nazi named Fritz Ballusek. Ballusek’s trial is well documented, but King was never caught. An example of the collaboration is from a letter on Nov 24, 1944 from Kinsey to King:

“I rejoice at everything you send, for I am then assured that that much more of your material is saved for scientific publication.”

Kinsey also warned his pedophiles to be careful not to be caught. For documentation, see Kinsey: Crimes and Consequences, whose author confirmed to me that she has the original tapes of the phone interview in her archives.

Although I did not call Nicole Prause a child molester, I did ask her then, and I ask her now, if she condones or refutes the collaboration of Kinsey, his coauthors, and the Kinsey Institute with child molesters. I am still waiting for her answer.

In 2019, leading sexology journal Archives of Sexual Behavior published a rare open-access piece about sexual harassment in the field of sexology, acknowledging Kinsey’s misdeeds:

Some of Kinsey’s biographies also included accounts of sexual behavior occurring between members of the research team (and their spouses) and highlight how some may have at times felt maneuvered into such sexual behaviors (Gathorne-Hardy, 1998; Jones, 1997). We feel that the Kinsey team’s inclusion of reports about infant and child genital response provided by one or more adults is especially egregious and concerning, for its time and ours. (emphasis supplied)

YBOP comments: Once again Nicole Prause has been caught in a lie.

Dr. Prause is obsessed with Dr. Hilton because he dared to critique the claims she made about her 2013 EEG study (Steele et al., 2013). Prause touted in the media that her study provided evidence against the existence of porn/sex addiction. Not so. Steele et al. 2013 actually lent support to the existence of both porn addiction and porn use down-regulating sexual desire. How so? The study reported higher EEG readings (relative to neutral pictures) when subjects were briefly exposed to pornographic photos. Studies consistently show that an elevated P300 occurs when addicts are exposed to cues (such as images) related to their addiction.

In line with the Cambridge University brain scan studies, this EEG study also reported greater cue-reactivity to porn correlating with less desire for partnered sex. To put it another way – individuals with greater brain activation to porn would rather masturbate to porn than have sex with a real person. Shockingly, study spokesperson Prause claimed that porn users merely had “high libido,” yet the results of the study say the exact opposite (subjects’ desire for partnered sex was dropping in relation to their porn use). Seven peer-reviewed papers explain the truth: 1, 2, 3, 4, 5, 6, 7.

Key point: Prause was given full opportunity by the journal to formally respond to Hilton’s critique. She declined. Instead, Prause attacked Hilton on social media and defamed him in emails.

Below are a few examples of Prause posting her lies on social media. Prause created a slide (naming Hilton, Gary Wilson, Marnia Robinson, Nofap, Alexander Rhodes) “proving” everyone she doesn’t like is “misogynist,” and continues to tweet it repeatedly to this day (maybe 40-50 times… so far):

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Notice how Prause tagged her friends at AVN (Adult Video Network, a porn producers interest group) in her tweet where she claimed that Dr. Hilton “screamed that she experimented on children”:

If Hilton screamed at Prause, why are Prause & Hilton pictured having a friendly discussion after the talk Prause attended?

Someone’s lying.

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Prause and David Ley on Facebook:

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In 2017 Prause tweeted the following about Dr. Hilton’s 2013 critique, while falsely stating that her Lancet commentary addressed criticisms put forth in the 5 peer-reviewed papers:

While Prause claims the film contained “misrepresentations and falsehoods about the science”, she couldn’t name any. Not one. She never does. Look at all of Prause’s tweets, Quora posts, Facebook comments, or even her two op-ed’s. She never provides any specific examples of misrepresentations. No excerpts from a study. No quote from the offender. Prause’s prime tactics are ad hominem and other defamation.

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Prause created over 25 usernames to post on reddit/pornfree and reddit/nofap. Here’s one of her many sockpuppets attacking Dr. Hilton:

As described above Prause has a history of personally attacking Alexander Rhodes (it is always Prause who initiates the harssment with her tweets). For example, (again) here’s Prause (on a thread she initiated) claiming that Alexander Rhodes lied about experiencing porn-induced sexual problems:

Key point: The above tweet no longer contains this picture of a man hiding in the bushes, which was used under the copyright “fair use” exclusion because it is evident the image’s purpose was for meme/parody:

Libel, perjury, and harssment – all documented. Prause reponded with this tweet and her ” misogyny infographic”, which she has tweetd about 30 times:

UPDATE – January, 2018: In response, Alexander Rhodes eventually sent in a counter notice, explaining to Twitter Inc. that as Dr. Nicole Prause is not the copyright holder or an authorized representative of the copyright holder, inconsistent with what she falsely asserted in the DMCA take-down notice sent to Twitter, the copyright infringement notice was baseless. In response, Twitter gave Dr. Prause a window of opportunity to respond to Rhodes’s counter-notice, in which she did not. While Twitter Inc. said that they would reinstate the censored tweet, the image has yet to reappear as of January 2018, despite the copyright decision being reversed. This demonstrates that while Alexander Rhodes and NoFap LLC successfully provided a legal argument against Prause’s censorship, she still was successfully able to permanently remove an image posted on Twitter through perjury without any tangible repercussions for breaking the law.

An earlier and significantly different version of this paper was first submitted in March, 2015 to the Yale Journal of Biology and Medicine for possible inclusion in its “Addiction” issue. Normal procedure is for the journal to have two academics review a paper to provide commentary and criticism. Key point #2: This paper was the only place Wilson’s affiliation with the Reward Foundation could be found outside of Foundation personnel. In other words, only the Yale Journal of Biology and Medicine editor and the two reviewers knew about this affiliation.

In April, 2015 an email by someone using a fake name (“Janey Wilson”) was sent to The Reward Foundation and to the organization housing several charities, including The Reward Foundation:

I now have documentation that Gary Wilson himself is claiming to be a member of the Reward Foundation. While he is not listed on the new website page, this represents a rather worse transgression…. [Reward Foundation personnel] may not even be aware he is making these claims, I am not sure, but he has now made them publicly.

Key Point #3: Only one of two reviewers of the Yale Journal of Biology and Medicine submission could have sent this email (Prause later self-identified as one of the two reviewers). The information was not public, but only made available to the journal.

Around the time that “Janey” (1) wrote The Reward Foundation to tell it about my “false” claim of affiliation, and (2) reported the charity itself to the Scottish Charity Regulator, “Janey” also wrote the Edinburgh organization where the charity is domiciled with false claims about me and The Reward Foundation. The Edinburgh entity is called “The Melting Pot.” It’s an umbrella organization that hosts various small enterprises. They contained the now familiar personal attacks on Wilson (described above), and even threats of legal action. No one took the bizarre rantings and unsupported claims seriously and “Janey” would not supply proof of her identity. “Janey” apparently simultaneously posted about this on the redddit/pornfree porn recovery forum – Gary Wilson is profiting from YBOP:

The above is hardly surprising as Prause has employed many sock-puppet identities to post, primarily on porn-recovery forums, about Wilson. For example hundreds of comments by Prause’s apparent avatars can be found at the links below. And, they are but an incomplete collection:

Another reddit/pornfree post that appeared about the same time (Prause deleted her sockpuppet’s username, as she often did after posting):

Janey/Prause made the irrational claim that I was “paying off” The Reward Foundation for a TEDx talk opportunity that occurred years earlier, in 2012. It had been arranged in 2011, years before the charity was conceived of or organized. Obviously, no such subterfuge was needed. I had the right to give my book proceeds to anyone at any point, or put them in my pocket. I chose the Reward Foundation because I respect its balanced, educational objective.

Neither organization (the Scottish Charity Regulator nor the Melting Pot) responded to “Janey,” as she offered no evidence, and wouldn’t identify herself, claiming “whistleblower status” (although, of course, she wasn’t an employee of either, and was not under threat). Had the charity not had a strong, respected relationship with the Melting Pot, and had it already been required to file financial statements with the Scottish Charity Regulator, “Janey’s” malicious claims might have done a lot of damage to the charity’s reputation and initiated a time-consuming, costly audit, etc.

In late 2016, Prause outed herself as “Janey Wilson” when she demanded (repeatedly and unsuccessfully) that Dan Hind of Commonwealth Publishing confirm my connection with the Scottish charity called The Reward Foundation to Prause in writing. Copying both MDPI (the ultimate publisher of the paper discussed earlier) and a publication ethics organization (COPE), Prause told Commonwealth’s Hind that he had already written her to this effect.

However, the only correspondence Hind had with anyone on the subject of Wilson and The Reward Foundation was with “Janey,” and he has stated this in writing. Thus, Prause has now outed herself as the former “Janey.” When Hind didn’t respond to Prause’s repeated demands, she then demanded the information via Commonwealth’s web designer – accompanied, as usual, by defamation and threat:

You may wish to encourage the site content owner that you designed to clarify that his author was caught claiming to “donate” proceeds from a book that actually went into his own pocket. Mr. Hind has failed to respond to inquiries with the Committee on Publication Ethics. I assume you would not want your name entangled in fraud like this in any way.

Prause seems to believe that the fact that my share of book proceeds goes to a Scottish registered charity, which I listed as my affiliation for purposes of two academic papers published in 2016, means that I am somehow pocketing the proceeds (from my own book) – and thus have a conflict of interest, which is purportedly grounds, in her mind, for my paper being retracted. Does any of this make any sense in light of the facts?

In fact, I am not on the Board of the charity, and certainly have no say over the book proceeds it receives as a consequence of my irrevocable donation. Incidentally, my affiliation is now public, as it is mentioned in both papers I published in 2016. In short, there is nothing hidden or improper going on, and no conflict of interest whatsoever – despite Prause’s claims behind the scenes and publicly.

Prause, a Kinsey grad and former academic, calls herself a neuroscientist, and appears to have started college about 15 years earlier. Not long after this revealing tweet “pornhelps” deleted both its Twitter account and website (pornhelps.com) – as it became apparent to others that Prause often tweeted with this account and helped with the website.

The following sections of this page provide examples of Prause and “pornhelps” simultaneously attacking and defaming some of Prause’s favorites targets (men who run porn-recovery forums, porn addiction researchers, TIME editor Belinda Luscombe, who wrote a cover story Prause didn’t approve of):

The Yale Journal of Biology and Medicine was informed of this behavior (apparently engaged in by one of their two reviewers). When it was suggested that Prause might be behind these bizarre emails and the paper’s initial rejection, the editor didn’t deny it. The paper was promptly accepted…and then not published after all, based on a claim that it was too late to meet the print deadline for YJBM’s “Addiction” issue.

A different, substantially updated version of the paper was then submitted to the journal Behavioral Sciences. After a few rounds of reviews and rewriting it was accepted as a review of the literature. Its final form was quite different from the original YJBM submission. During this process, the paper was reviewed by no fewer than 6 reviewers. Five passed it, some with some suggested revisions, and one harshly rejected it (Prause, again). As part of this process, the authors were given all of the comments by the reviewers (but not their identities). The reviewers’ concerns were thoroughly addressed, point by point.

From these comments, it became evident that the “harsh reviewer” of the Behavioral Sciences paper had also reviewed the paper at YJBM.About a third of the 77 points raised did not relate to the Behavioral Sciences submission at all.They referred to material that was only present in the earlier version of the paper, the one that had been submitted to YJBM. At a much later date, Prause submitted the original YJBM version to a regulatory board (in an effort to have the published paper retracted), thus confirming she was the person behind the many harassing “Janey Wilson” emails.

In the course of her attacks on the paper’s authors, Nicole Prause has violated the Committee on Publication Ethics (COPE) code of ethics for academic reviewers multiple times. Section 5, in the “Guidelines on Good Publication Practice” PDF (on this page) outlines eight rules for peer reviewers. Nicole Prause has violated at least three COPE’s rules:

(2) The duty of confidentiality in the assessment of a manuscript must be maintained by expert reviewers, and this extends to reviewers’ colleagues who may be asked (with the editor’s permission) to give opinions on specific sections.

Prause broke confidentiality. She used Wilson’s affiliation with The Reward Foundation to harass the officers of the Reward Foundation and to pepper the Scottish Charity Register with false allegations about Wilson.

(3) The submitted manuscript should not be retained or copied.

Prause kept the manuscript and later submitted it to regulatory boards as part of a frivolous demand for retraction. (Apparently, she never realized the paper had been accepted by YJBM once her review was disqualified.)

(4) Reviewers and editors should not make any use of the data, arguments, or interpretations, unless they have the authors’ permission.

Prause used specific content of the YJBM submission as a part her bogus claim to regulatory boards without the authors’ permission.

Update: In May, 2018 Prause falsely claimed to journal publisher MDPI (and others) that, based on the charity’s recent public filing (with a name redacted, as is standard), expense reimbursements paid to a charity officer were in fact paid to me. I forwarded Prause’s claim to Darryl Mead, Chair of The Reward Foundation, who debunked Prause’s claims: See for the documentation.

On October 15, 2015 Gary Wilson received a cease and desist letter from a lawyer representing Nicole Prause. A year later Prause published her cease and desist letter on AmazonAWS, and linked to it under a petition to Psychology Today (asking the organization to reconsider its editorial policy). Prause commented under the petition multiple times saying that members of two organizations (IITAP & SASH) were all “openly sexist and assaultive to scientists.” In a strange disconnect, the main evidence Prause supplied for this blanket statement was the cease and desist letter sent only to Wilson, reproduced below. Wilson is not a member of SASH or IITAP.

There is no other way to say this: All four claims in the above cease & desist letter are bogus. The most absurd claim is that Wilson said that Prause appeared in porn. Gary Wilson wrote the following letter asking both Prause and the lawyer to provide evidence to support their allegations. Wilson’s letter in full:

In the intervening 3 years neither Prause nor the lawyer have responded. Neither has provided any evidence to support Prause’s allegations – because the allegations are false. It’s clear that Prause’s motivation was threefold:

to intimidate Wilson so that he might remove his critiques of Prause’s studies,

to create a letter she could show her allies as “proof positive” that Wilson is harassing her (even though it is proof of nothing and merely made up),

to produce an “official letter” to show journalists so as to discourage them from contacting Wilson.

Prause continues to spin a fable that Gary Wilson has threatened to “show up” at one of her talks. This is poppycock. Prause has provided no evidence to support this claim, and Wilson has no desire to hear Prause speak (let alone pay to hear her speak). In mid-October, 2016 Nicole Prause placed the following PDF on AmazonAWS. Prause posted a link to the PDF under a petition to Psychology Today (which was gathering support to ask the organization to reconsider its editorial policy).

While nothing in this message (below) can be verified, it appears to be written by Susan Stiritz. It also appears to be describing Stiritz relaying Prause’s fabricated claim to a campus policeman to the effect that Gary Wilson was planning to attend the AASECT summer institute. Put simply, Wilson was claimed to be planning to fly 2000 miles, pay for 4 nights in a St Louis hotel, and pay over $1000 to AASECT, just to hear Prause and David Ley explain how porn addiction has been “debunked.” Prause even provided a picture of Wilson, which she must have “stolen,” because he didn’t send it to her (reproduced below).

So this is the “proof” that Gary Wilson is dangerous: a made-up tale by Prause, told to a friend, who relayed it to a campus cop 2000 miles from where Wilson lives via message, which Prause now offers as “proof” of Wilson’s evil actions. What’s missing from all of this claptrap is one iota of evidence that hints that Wilson ever indicated that he intended to attend a Prause lecture – or threaten her in any way whatsoever.

While Prause claims Wilson is “dangerous,” the only danger of having Wilson in the audience is that he might, with awkward questions, debunk Prause’s claims by citing more than 3 dozen neurological papers that support the porn addiction model, and 85 studies that link porn use to sexual dysfunctions and lower sexual & relationship satisfaction. That’s the real reason she doesn’t want Wilson attending her lectures.

Prause has a history of sending cease and desist (C&D) letters to people who question her academic credentials and expertise. She claims to have sent (at least) seven such letters, which she has repeatedly mischaracterized on social media as “no contact orders.” Only courts and regulatory bodies issue “orders,” as that word is commonly understood, and only then after giving both parties the chance to be heard. Prause’s C&D letters to anyone who questions her come from her lawyer, not a judge, and seem expressly intended to stifle criticism and honest debate.

Worse, on the basis of merely sending these unsubstantiated letters, Prause insists she has the legal right to prevent anyone who has received such a letter from defending against, or replying to, her demeaning online statements about them or others – even if they simply wish to supply evidence that counters her untrue statements. When those letter recipients try to speak out, she publicly and falsely accuses them of “violating no contact orders” and of “harassment.” The clear, and clearly false, implication of her statements is to suggest these people are acting illegally.

To our knowledge, Prause has never obtained a court or regulatory order against any C&D letter recipient. Her aggressive tactics and knowingly false accusations instead appear calculated to bully and intimidate her detractors into silence.

Prause has also used a modified version of this tactic against Rhodes and PornHelp.org, among others by attacking them and their speech online, then if they dare to correct or defend, publicly demanding they “not contact [her] by any means.” If they subsequently dare to correct a falsehood or call her out, she accuses them of violating a “no contact” and threatens to sue. And then, despite her demand, she continues to attack them online in the future.

A number of the C&D letters Prause has posted online or sent are reproduced as images below. Prause placed links to three of her C&D letters on her Amazon AWS pages (C&D 1, C&D 2, C&D 3), presumably so that she could easily link to each in tweets, on Facebook, and in the comment sections under online articles. To repeat: we are not aware of Prause ever acting on any of the aggressive, albeit empty, threats in these letters. We believe they are intimidation tactics, pure and simple. Finally, the recipients of the C&D letters emphatically state that Prause’s lists of wrongdoings were manufactured lies. Anyone can pay an internet-based lawyer to write spurious C&D letters.

Four of the five C&D letters are reproduced below. The 5th C&D letter, and Wilson’s reply to Prause’s lawyer, are in this section.

Linda Hatch PhD

Prause addressed Linda Hatch as “Ms.” instead of “Dr.” in the letter, (an error that Prause has repeatedly insisted is incontrovertible proof of “misogyny”). Note that Prause had her lawyer cruelly copy the editor of a site where Dr. Hatch regularly blogs. Prause posted 4 of the cease & desist letters publicly on amazonaws.com. It’s clear that the bogus C&D letters were meant to “punish” the recipients for thoughtfully critiquing Prause’s flawed studies and challenging Prause’s unsupported claims.

In the above C&D letter Prause claims that Weiss misleadingly stated that Prause no longer has a university affiliation. While there is no evidence that Weiss said this – Prause isn’t affiliated with any university.

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Marnia Robinson, JD

It’s entertaining that Prause accused Robinson of saying that Prause is no longer employed by a university and that her contract with UCLA was not renewed – when both are true. The reality behind Prause’s so-called no-contact request is exposed in the very first section of this page. Since Prause’s April, 2013, no-contact request Prause and her sockpuppets have posted hundreds of libelous comments on social media and elsewhere. In Prause’s twisted world it’s OK for her defame and harass others, but no one is allowed to defend themselves from her abuse.

OTHERS – October, 2016: Prause states falsely that SASH and IITAP “board members and practitioners are openly sexist and assaultive to scientists“

On October 12, 2016 a petition to Psychology Today (asking the organization to reconsider its editorial policy) was published on “petitionbuzz.com” The next day Nicole Prause & Jim Pfaus posted four comments under the petition. Prause & Pfaus co-authored this paper (it’s not an actual study), that they claim debunked porn-induced ED. Two peer-reviewed papers (paper 1, paper 2) and three lay critiques say otherwise (1, 2, 3). As do 25 studies linking porn use to sexual problems. Under the petition, Jim Pfaus calls SASH and IITAP “addiction cults” and “snake oil salesmen” (Pfaus is not a therapist). He also falsely claims that there’s “no empirically-based clinical or biological science supporting porn addiction or the negative effects of porn use.”

Nicole Prause posted 3 more comments, including this one where she claims that all members of IITAP and SASH are “openly sexist” and “assaultive to scientists”:

What evidence does Prause provide to incriminate all the members in these two very large and diverse organizations, accusing them all of “sexism and assaults on scientists?” Prause posts links to her fabricated claims about Gary Wilson (described above). Since Wilson is not a member of either organization, it’s baffling how Prause’s ramblings about Wilson incriminate over a thousand therapists, PhDs, medical doctors and psychologists belonging to these two organizations. Once again, we have inflammatory and defamatory claims without a shred of evidence.

A few examples Prause harassing SASH on twitter:

Her silly little inforgraphic, which includes the entirety of her evidence:

Working as one, Prause tweets a David Ley blog post libeling IITAP. The blog post was removed by Psychology Today:

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Tags IITAP in a article that has nothing to with sex or porn addiction. Typical mischaracterization, combined with cyber-stalking:

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Prause creates a logo to harass IITAP members on twitter: “I FAP (masturbation) before IITAP”

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No Fraud, but Prause did file a spurious claim (as Prause so often does) with a journal, claiming the data wasn’t quite right. The Journal and publisher were forced to look into Prause assertions – and found nothing to her claims. No one ever does. Anyhow, Prause’s twitter falsehoods related to this manufactured incident:

David Ley joins in with his blog post that was removed from Psychology Today:

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More harassment over a 2 year old critique of Prause & Pfaus, 2015:

Another:

Prause & Pfaus 2015? It wasn’t a study on men with ED. It wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. It’s disturbing that this paper by Nicole Prause and Jim Pfaus passed peer-review as the data in their paper did not match the data in the underlying four studies on which the paper claimed to be based. The discrepancies are not minor gaps, but gaping holes that cannot be plugged. In addition, the paper made several claims that were false or not supported by their data. Prause & Pfaus 2015 as these 2 critiques expose, it cannot support a single claim it made, including Prause’s claim that they measured sexual response:

The above comment was made in a general response to dozens of Nicole Prause comments where Prause personally attacked therapists and organizations (IITAP, SASH, ASAM) for supposedly “profiting from sex and porn addiction.” Prause has spent the last 4 years obsessively posting on the ICD-11 beta draft, doing her best to prevent the CSBD diagnosis from making it into the final manual. In fact, Prause posted more comments than everyone else combined. (Her attempt failed, as “Compulsive Sexual Behavior Disorder.” is now in the ICD-11)

Who’s the cyber-stalker when Prause tweets over 1oo times about IITAP or Carnes, while IITAP & Carnes never tweet about Prause?

California Proposition 60 would have mandated condom use in porn films. It was supported by AIDS Healthcare Foundation (AHF), a nonprofit HIV/AIDS care and advocacy organization, and vehemently opposed by porn producers and interestingly enough, Nicole Prause and colleague David Ley. In the run up to the 2016 election, Prause and Ley seemed obsessed with defeating Prop 60, while relatively unconcerned about graver issues such as health care, immigration, or jobs. Both Prause and Ley spent considerable effort tweeting and re-tweeting attacks on Prop 60, and support for the Free Speech Coalition, the lobbying arm for the porn industry (tweet1, tweet2, tweet3, tweet4, tweet5, tweet6, tweet7, tweet8, tweet9, tweet10, tweet11 – NOTE: Prause deleted many of these tweets in April, 2016). One such example of Prause supporting the porn industry:

Freelancer? While Prause’s degree is in statistics, Keren Landman MD is a researcher, medical epidemiologist, and infectious disease specialist who once worked for the U.S. Centers for Disease Control and Prevention. HIV infection is one of her specialties, having published several papers in the field. Once again, we have Prause personally attacking experts in a field, while simultaneously failing to support her position with empirical evidence. (Does anyone believe Prause’s claim that “every independent scientist supports prop 60″?) Whatever anyone thinks about Prop 60, Dr. Landman’s position is supported by research, and Nicole Prause’s is not.

The question remains: Why are both Prause and Ley such outspoken supporters of the porn industry, and so eager to attack anyone and everyone who suggests porn use or sex without a condom may pose problems?

On November 10, 2016 “Mormon Matters” published the following podcast: 353–354: Championing the “Addiction” Paradigm with Regard to Pornography/Sex Addiction. It was a response to an earlier Mormon Matters podcast (episodes 347–348) where Prause and three therapists tried their very best to debunk porn addiction and sex addiction. In Podcast 353–354, Mormon Matters host Dan Wotherspoon was joined by four panelists: Jackie Pack (LCSW, CSAT–S, CMAT), Alexandra Katehakis (MFT, CSAT-S, CST-S), Stefanie Carnes (Ph.D., CSAT-S), and Donald Hilton (M.D.).

Within a few minutes of the podcast going live, Nicole Prause and, apparently, her sock puppets (“Skeptic”, “Lack of expertise on panel”, “Danny”) posted a dozen comments attacking the four panelists. Prause & sock puppets was joined in her ad hominem fest by Jay Blevins and Natasha Helfer-Parker (two of the therapists who collaborated with Prause on episodes 347-348). Over the next few days, Prause, Jay Blevins, and Natasha Helfer-Parker posted dozens more ad hominem comments. Nicole Prause posted her typical lies about Gary Wilson stealing photos, having to lock down her lab, and “fortifying her home” (maybe she installed a bomb-shelter to protect her from unfavorable blog posts). Also, in one of her numerous comments, Prause claimed that:

She had sent Cease & Desist letters to members of the panel

Two of the panelists are currently under APA investigation

Prause’s comment:

We contacted the panelists, and it was confirmed that:

No panelist has received a cease and desist letter from Dr. Prause, and

No panelist has been contacted by the APA (the American Psychological Association).

Once again, we have evidence that Nicole Prause is making false statements. And suppose Prause had actually sent cease and desist letters? It would be evidence of nothing, as anyone can pay a lawyer to send a spurious cease and desist letter (as Prause is wont to do).

Update: All of the many comments under podcast: 353–354, including several libelous ones by Prause, have mysteriously disappeared. Is this another instance of Prause trying to cleanup her public image? (In April of 2018 she deleted hundreds of her libelous and harassing tweets.)

Nicole Prause created a username called “PornHelps”, which had its own twitter account (@pornhelps) and a website promoting the porn industry and cherry-picked studies reporting the “positive” effects of porn. Prause’s “PornHelps” chronically badgered the same people and organizations that Prause often attacked. In fact, Prause would team up with her alias PornHelps to attack individuals on Twitter and elsewhere in tandem with her other identities. Some of the Prause/PornHelps coordinated attacks are documented in these Prause-page sections:

The @pornhelps twitter account and PornHelps website were suddenly deleted when it became apparent to that Prause was the individual behind both. While many of us being attacked knew “PornHelps” was really Nicole Prause, the following @pornhelps tweet left no doubt:

Prause, a Kinsey grad, calls herself a neuroscientist, and appears to have started college about 15 years earlier than the above 2016 tweet. In response to several ad hominem attacks by “PornHelps”, which perfectly mirrored many of Prause’s usual comments, “PornHelps” was confronted in the comments section of Psychology Today with this and other evidence: https://www.psychologytoday.com/us/comment/887468#comment-887468

Within a few days of the above Psychology Today comment the PornHelps website and @pornhelps twitter account vanished without a trace! All that remains of PornHelps are a smattering of comments on various sites and this abandoned disqus account (listing 87comments).

Want more confirmation that PornHelps was really Prause? The following comments, tweets, and coincidences make it apparent.

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Here Prause and Russell J. Stambaugh simultaneously comment under an article about porn. Prause & Stambaugh are close allies and often comment together in pre-planned assaults in comment sections.

At the same time that Prause tweeted the above, “PornHelps” began posting in the comments section below the paper. A few of PornHelps’ comments below. How does PornHelps know so much about research methodology and statistics? (Prause’s PhD was in stats):

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And here’s more confirmation that PornHelps is Prause. The PornHelps comments under an NPR interview of Prause are nearly identical to Prause’s usual spin about the claimed benefits of porn:

Now a taste of Prause (as PornHelps) attacking Wilson on various websites: promoting porn and misrepresenting the current state of the research. (Note: PornHelps was very busy attacking others on PT and other websites, and of course, via Twitter).

The following are some of the over 20 comments under the Prause op-ed by PornHelps. Prause’s #2 obsession after Gary Wilson is FTND, which Prause has tweeted about over 100 times. The comments perfectly mirror Prause tweets misrepresenting the research and attacking FTND.

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PornHelps mentions the same Australian study that Prause tweets all the time:

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Here PornHelps mirrors dozens of Prause tweets or comments – both naming the exact same findings from outlier studies.

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Another example of Prause/PornHelps attacking Wilson (while teaming up with David Ley). Many more examples can be found on this page.

Here is the paragraph from IITAP’s response that linked to the Prause Quora post. (Keep in mind that Prause was an instrumental figure in misleading a small band of AASECT therapists that porn and sex addiction had been debunked – not the case).

On the other side, many clinicians are expressing worry that people who truly are sexual addicts are harmed by well-meaning sex therapists who without insight or full understanding of these issues discount the problematic nature of these symptoms, thus writing off a client’s compulsive sexual behavior patterns as normal and non-consequential, even suggesting that clients’ issues are related more to their attitude about sex than the sex itself. This stance is clearly harmful to those clients who are getting and sharing STD’s with unwitting partners and/or losing marriages, jobs and educational opportunities due to self-described excessive porn use, online hook-ups and the like. Consider, for instance, the recently published blog from a well-known researcher, and AASECT faculty member that recommended that someone with a porn addiction should go see a sex worker instead of masturbating to porn (since the posting of this article this blog has been removed). From the IITAP educational perspective, such blatant disregard of compulsive behavior can without question be harmful to the client and those close to him or her.

Prause’s suggestion to visit a prostitute is in the last paragraph:

While this is not harassment, it’s relevant because it shows a complete disregard for professional ethics, ethical and social norms, and the rule of law. This theme permeates everything revealed about Nicole Prause on this page.

OTHERS – December, 2016: Prause reports Fight the New Drug (FTND) to the State of Utah

Nicole Prause seems to tweet more about Fight The New Drug (FTND) than she does about her or others’ research. A quick look reveals that Prause tweeted 35 times about FTND in November & December 2016.

On December 19, 2016, Prause wrote an e-mail to the Utah State Division of Child and Family Services (DCFS), in which she accused Fight the New Drug in its online Fortify program (an online educational curriculum for teens and adults seeking to overcome compulsive pornography use) of both “soliciting sexual stories from children” without parental consent and “coercing” children to provide these stories. While underscoring that she was a “licensed psychologist in California (CA #27778)” and a “mandated reporter” the single reference she provided to support her initial claim was a hit-piece from an online website called “Harlot Magazine.”

Nicole CC’d the CEO of Fight the New Drug (FTND), Clay Olsen, on her complaint to DCFS. Subsequent phone calls from FTND to DCFS revealed that (while they could officially neither confirm nor deny whether an investigation was taking place) (1) the accusation from Prause meets none of the criteria for something DCFS investigates, and (2) it was not necessary for FTND to meet with DCFS since there was “nothing to investigate” and “nothing to explain.”

Despite all this, Prause continued publicly tweeting her concerns about “@FightTheNewDrug child victims” and posted the following request to all her twitter followers, “if your child completed @FightTheNewDrug Fortify program, asking sexual hx, Utah DCFS wants to talk to you. This how to get heard.”

Several more related tweets, containing factually incorrect & inflammatory drivel, which the state of Utah determined to be empty rhetoric:

Prause went so far as to produce short YouTube videos to harass FTND and researchers:

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Prause escalates the rhetoric, accusing FTND of coercion and ultimately of pedophilia!

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In the following tweets Prause inudates @delmonater with her unsupported propagand (which the state of Utah rightfully ignored)

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Below is Prause’s ever-present info-graphic, calling everyone she harrases a misogynist, while providing zero evidence to support her falsehoods. Over the last few years, Dr. Prause appears to have taken great pains to position herself as a “woman being subjected to misogynistic oppression when she tells truth to power.” She frequently tweets this infographic that she apparently also shares at her public lectures, suggesting she is being victimized “as a woman scientist,” and painting herself as a trailblazer forging ahead to prove porn’s harmlessness despite prejudiced attacks. She has even been known to tweet combinations of misogyny claims and claims that (legitimate, peer-reviewed) science with which she disagrees is “fake.” Any suggestion that FTND, Don Hilton, Wilson, Gabe Deem or Alexander Rhodes are motivated by misogyny is fabricated, as their objections have nothing to do with Dr. Prause as a person or as a woman, and only to do with her untrue statements and inadequately supported claims about her research.

This next tweet contains Prause’s second “info-graphic” she regularly tweets. It lists FTND, SASH, IITAP, YBOP, NoFap.com, RebootNation, PornAddiction.com, and others as “fake news” websites” while listing only two websites as having accaurate information about pornography’s effects: 1) Justin Lemillers website (a paid writer for Playboy); 2) AASECT, which is not a sceintific organization (debunking of AASECT’s proclamation that porn/sex addiction doesn’t exist).

The preceding tweets are but a small sample of Prause’s tweets and Facebook comments defaming and disparaging FTND. Prause’s claims she is victim, yet she is the perpetrator.

Thus Prause continues her pattern of misusing regulatory bodies for unwarranted complaints – partly as a way to intimidate individuals and organizations and partly as a way for her to subsequently use her own specious and defamatory accusations in broader media opportunities.

Once again, Prause launches an unprovoked, defamatory twitter attack on a man who recovered from porn-induced ED. The following Prause tweet seems to be related to Noah’s appearance on the DearSugarRadio segment “My Fiancé Is Addicted To Porn“.

Was Noah scientifically inaccurate? Nope. As is usual, Prause fails to describe the supposed inaccuracies.

provided one-on-one coaching and advice to those recovering from porn addiction and porn-induced ED

Is Noah religious? Nope. He is an atheist, which he has stated many times in past.

Is Noah a profiteer? His book, videos and website are all given freely. Noah only charges for one-on-one coaching because it’s so time-consuming.

We assume that Dr. Prause doesn’t treat clients for free (if she sees clients). We know that Prause offered (for a fee) her “expert” testimony against sex addiction and porn addiction. She also receives payment for speaking engagements where she debunks porn and sex addiction.

Finally, consider the fact that it is a violation of APA (American Psychological Association) principles for psychologists to attack those trying to recover.

Prior to the publication “The Routledge International Handbook of Sexual Addiction” Prause tweets that the book’s “only neuroscience chapter was written by a person with no neuroscience training”:

The chapter in question is 3.2 – “The Neuroscience of Sexual Addiction” and was written by Frederick M. Toates DPhil DSc.

The 73-year old Toates is Emeritus Professor of Biological Psychology at The Open University and Vice-President of the Open University Psychology Society. He is not only trained in neuroscience, he is a professor of biological psychology (neuroscience).

With two doctoral degrees, Frederick Toates is a pioneer in the study of motivational systems (the reward system), especially in relationship to sexual desire and motivation. His latest book: How Sexual Desire Works: The Enigmatic Urge. Professor Toates was publishing biological research and authoring neuroscience books before Nikky Prause was a gleam in her parents’ eyes. While Professor Toates is still actively publishing and working in academia, non-academic Prause hasn’t been associated with a university for over 2 years.

MDPI is the Swiss parent company of numerous academic journals, including Behavioral Sciences. Prause is obsessed with MDPI because (1) Behavioral Sciences published two articles that Prause disagrees with (because they discussed papers by her, among hundreds of papers by other authors), and, (2) Gary Wilson is a co-author of Park et al., 2016. The two paper:

A few days after Park et al.‘s publication Prause insisted that MDPI retract it. The professional response to scholarly articles one disapproves of is to publish a comment outlining any objections. Behavioral Sciences’s parent company, MDPI, invited Prause to do this. Prause declined the offer and demanded (unwarranted) retraction instead. Since Park et al.’s publication Prause has been trying every weapon in her arsenal to have the paper retracted (including sending bogus complaints to the medical boards of all 7 physicians who co-authored the paper). Her emails to MDPI officials, filled with spurious claims and easily debunked allegations, have failed to achieve her goal. No one on the receiving end of her invective had ever witnessed such bizarre behavior by a researcher.

Most unprofessionally, she has turned to threats and social media (and most recently the Retraction Watch blog) to bully MDPI into retracting Park et al. In addition, she informed MDPI that she had filed complaints with the American Psychological Association and the doctors’ medical boards. She also pressured the doctors’ medical center and Institutional Review Board, causing a lengthy, thorough investigation, which found no evidence of wrongdoing on the part of the paper’s authors.

Having failed to bring about an unmerited retraction, Dr. Prause has continued to make untrue statements about the journal itself, claiming that Behavioral Sciences is a predatory journal (it isn’t – it’s PubMed indexed), and that Park et al. was never reviewed (normally a journal sends a paper to 2 reviewers for comments and criticisms). In reality, the paper was reviewed at least 6 times that we know of (for Behvavioral Sciences alone), including one very antagonistic review from Dr. Prause – who later indirectly identified herself as the person who reviewed not only the Behavioral Sciences submission, but an earlier, much shorter version of the paper, submitted to Yale Journal of Biology and Medicine (YJBM).

In many of her emails to MDPI (and others), Prause mentioned her “77 criticisms” and falsely claimed that they had not been addressed. In reality, many of the 77 so-called problems were carelessly copied and pasted from Prause’s review of the YJBM submission; 25 of them had nothing to do with the Behavioral Sciences submission. In other words, the only reviewer to condemn the paper had cut and pasted dozens of criticisms from a review done at another journal (YJBM), which no longer had any relevance to the paper submitted to Behavioral Sciences. This is highly unprofessional.

Even apart from that glaring irregularity, few of the 77 problems could be considered legitimate. Yet, we carefully combed through each comment mining for useful insights, and wrote a comprehensive response to all comments for Behavioral Sciences and its editors. Almost all of the remaining 50 critical comments were either scientifically inaccurate, groundless, or were simply false statements. Some were repetitive. The authors provided MDPI with a point by point response to each so-called problem.

Prause is claiming that publisher MDPI is on predatory journal list cataloged by librarian Jeffrey Beall. This assertion is false, and there’s no list associated with the link Prause tweeted. MDPI does not publish predatory journals. In fact, it was investigated years ago after it was mistakenly placed on a predatory list, and formally determined to be a legitimate publisher. See: http://www.mdpi.com/about/announcements/534. The man (Jeffrey Beall) who made the error eventually deleted his entire operation

MDPI responds:

Prause Twitter rampage has continued (a few of her tweets below):

MDPI responds to Prause:

CEO of MDPI Franck Vazquez, Ph.D, also responds, as does Prause:

Prause keeps going (MDPI eventually ignores her Twitter tagging):

Has Prause been trying to have MDPI thrown out of PubMed and other indices based on her untruths? Three tweets from August, 2016 – just a few weeks after Park et al., 2016 was published:

Here Prause plays her favorite card – accusing others of misogyny – without a shred of evidence (just as she has done with me and multiple others).

More false accusations of misogyny:

Prause falsely claims the Behavioral Sciences paper she attacked was retracted. This is both defamatory and unprofessional.

The Twitter conversation continues:

After a lengthy, thorough, time-consuming investigation, MDPI decided not to retract the paper, and circulated a draft editorial criticizing Prause’s unprofessional behavior. As soon as Prause was informed, she initiated an unprofessional, untruthful email exchange with MDPI – copying bloggers David Ley (her close colleague) and Retraction Watch among others. On the same day of this email barrage harrasing and threatening MDPI, Prause employed multiple Wikipedia usernames (which violates Wikipedia rules) to edit Wikipedia, inserting false information about MDPI and attacking the authors of Park et al., the MDPI president, and two others in the organization.

While Prause’ email threats are not on social media (yet), she has copied bloggers who are positioned to damage the reputations of MDPI in the media, if they choose. Ley blogs on Psychology Today and has often served as the Mouth of Prause. Neuro Skeptic has a popular blog that disparages legitimate (and sometimes dubious) research. Adam Marcus writes for Retraction Watch. Prause also copied Iratxe Puebla, who works for COPE, an organization that addresses publication ethics. Already, a blogger from Retraction Watch has begun investigating the matter, demanding comments on various unsupported, Prause-like claims of impropriety.

· 19:06, 19 January 2015 (diff | hist) . . (-9,453)‎ . . Pornography addiction ‎ (This section talked only about delta fos-B, which has never been investigated with respect to erotica. Gary Wilson, a known porn blogger who makes money from porn “addiction” added this section, as he is the only one promoting it. It should be removed.) (Tag: section blanking)

Naming “Gary Wilson” is a dead give-away that the above user account is Nicole Prause. Reality Check: Gary Wilson makes no money related to this endeavor, and he did not add the DeltaFosB section to the “Pornography Addiction” Wiki page. As time passed, Prause fell back into her usual pattern of creating usernames with 3-4 capitalized words. For example:

While the above edits suggest that all are Prause as they consistently attack IITAP, Carnes, the addiction model, and falsely claim there’s no science supporting either porn or sex addiction. If there was any doubt, two of them once again comment about Gary Wilson and DeltaFosB. First, a telling “PatriotsAllTheWay” comment:

A few comments: 1) All of Gary Wilson’s profits from the sales of his book go to charity, and his website is otherwise entirely non-commercial; 2) Contrary to Prause’s claim, DeltaFosB is present in humans and all neuroscientists studying its mechanisms agree that DeltaFosb is involved with multiple physiological functions, including sensitization to sexual activity and addiction.

A Wikipedia “user-page” is automatically created for every username that edits a Wikipedia article. “NotGaryWilson” is the only Prause sock puppet to have made a comment on its user page. Here’s what “NotGaryWilson” wrote about the “Sex Addiction” article:

As you are probably aware, anti-porn groups repeatedly sabatoge these pages for profit. Delta FOSb has no direct support, but is a pet idea from Gary Wilson, paid anti-porn activist. So, yes, I did mean to remove the text and will go ahead and remove it again. I will add the justification back. There is no evidence supporting the connections Wilson makes, which is why it is so easy to spot his writing.

As with the “Pornography Addiction” Wikipedia page, Gary Wilson in fact added none of the DeltaFosB material to the “Sexual Addiction” Wikipedia page. As stated, Wilson is paid by no one, and makes no money on this endeavor. Finally, only non-academics David Ley and Nicole Prause ever assert that DeltaFosB is not involved with initiating addiction-related brain changes. (Prause is particularly obsessed discrediting with DeltaFosB.) Contrary to their unsupported rantings, DeltaFosB’s role in addiction and sensitization is well established in both animal and human studies (see list 1 and list 2 for DeltaFosB studies). A veteran Wikipedia editor responds to the above comments by “NotGaryWilson”:

I’m C.Fred. I noticed that you recently removed some content from Sexual addiction without adequately explaining why. In the future, it would be helpful to others if you described your changes to Wikipedia with an accurate edit summary. If this was a mistake, don’t worry; the removed content has been restored.

And,

It’s pretty clear from your username that you have an axe to grind with the topic. Chopping broad sections from the article is not a constructive way to go about this. You need to discuss your changes on the talk page and get broad support for them. —C.Fred (talk) 00:48, 16 January 2017 (UTC)

Don’t hold your breath for broad (legitimate) support for unsupported claims about Wilson or DeltaFosB. Sometimes Prause uses an IP address as a username. This Wikipedia user only edited “Sex Addiction” blabbering on about “FosB” and CSATs & IITAP – two of Prause’s favorite targets:

What makes us suspect that both usernames are Nicole Prause? Not only did both usernames edit only the FTND Wikipedia page, both created the section featuring Prause’s often-tweeted op-ed that appeared in the Salt Lake City Tribune. Prause wrote the critique of Fight the New Drug’s previous op-ed, then persuaded 7 of her PhD buddies to sign off on it. Prause’s op-ed cited only a few irrelevant citations, while offering no neuroscience-based studies. It also made several false statements about the content and references in the earlier FTND op-ed. Several experts responded with this dismantling of the Prause op-ed: Op-ed: Who exactly is misrepresenting the science on pornography? (2016).

Perhaps upset that SASH’s new Position Paper dared to look to the preponderance of neuroscientific evidence on the subject of sexual behavior addiction instead of looking to Prause’s assertions, Prause tweeted the following unjustifed, retaliatory claims. SASH has never commented on Prause.

Prause’s typical tactics are two-fold: 1) disparage every study that links porn use to negative outcomes, 2) personally attack those involved with the study. These behaviors serve her goal, which is to “prove” that porn use is rarely harmful, and almost always beneficial. In this tweet she disparages a study by US navy urologists, saying they are “activists, not scientists.”

Prause follows this attack with her own “official” press release attacking the study, which Prause has never seen. A second Prause tweet asserts that the medical doctors “ducked from reporters due to shame.” This is found nowhere in the article Prause tweeted and Prause did not attend the urology conference where the paper was presented:

It must be noted that Prause’s own “ED paper,” Prause & Pfaus 2015, wasn’t a study at all. Instead, Prause claimed to have gathered data from four of her earlier studies, none of which addressed erectile dysfunction. Additional problem: The data in the Prause & Pfaus (2015) paper do not match the data in the four earlier studies. The discrepancies are not small and have not been explained.

Many journalists’ articles about this study claimed that porn use led to better erections, yet that’s not what the paper found. In recorded interviews, both Prause and Pfaus falsely claimed that they had measured erections in the lab, and that the men who used porn had better erections. In this Jim Pfaus TV interview Pfaus states:

“We looked at the correlation of their ability to get an erection in the lab.”

“We found a liner correlation with the amount of porn they viewed at home, and the latencies which for example they get an erection is faster.”

In this radio interview Prause claimed that erections were measured in the lab. The exact quote from the show:

“The more people watch erotica at home they have stronger erectile responses in the lab, not reduced.”

Yet this paper did not assess erection quality in the lab or “speed of erections.” The paper only claimed to have asked guys to rate their “arousal” after briefly viewing porn (and it’s not clear from the underlying papers that even that actually happened in the case of all subjects). In any case, an excerpt from the paper itself admitted that:

“No physiological genital response data were included to support men’s self-reported experience.”

OTHERS – September 14, 2017: Prause claims all who believe porn can be harmful and addictive are “science-illiterate & misogynistic”

Continuing her behind-the-scenes pattern of filing baseless, harassing complaints against anyone whose views Prause disagrees with, Prause filed two unfounded complaints against therapist Staci Sprout, accusing Sprout of “conspiracy theories.” This was after falsely accusing her on a Facebook post comment of practicing without a license. Note that Prause tried to persuade the State of Washington to hide Prause’s bogus complaint from Sprout. Because the complaint was baseless, Prause was not considered a whistleblower, and identity was not protected – despite a second complaint by Prause insisting she had whistleblower status.

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According to the records, Washington received Prause’s complaint on January 24th, and the case was opened on January 30th. Two days later (February 1st) the State of Washington dismissed the empty complaint (without an investigation) and closed the case, declaring that even if the allegations were true, no violation of law would have occurred.

To understand Prause’s dishonesty and irrational action look at her “complaint” to the State of Washington. Prause targeted the following Sprout post, which is found on the Compulsive sexual behaviour disorder section (CSBD) of the ICD-11 (you can’t read the comments unless you create a username):

Again let us not neglect to consider the financial interests of those who benefit by the billions from unidentified, untreated compulsive sexual behavior. Two easy examples: “free” pornography sites who are paid for advertising, and drug manufacturers of ED drugs. They might even have lobbyists.

Context: The above comment was made in a general response to dozens of Nicole Prause comments where Prause personally attacked therapists and organizations (IITAP, SASH, ASAM) for supposedly “profiting from sex and porn addiction.” Prause has spent the last 2 years obsessively posting on the ICD-11 beta draft, doing her best to prevent the CSBD diagnosis from making it into the final manual. (Her attempt failed, and CSBD is now in the ICD-11 – see below.) In fact, Prause posted more comments than everyone else combined.

When Sprout dared to point out the more likely profiteers, Prause reported her to Washington State! Here’s Prause complaint to the Board:

Violation: Stated that we had “lobbyists” and that “pornography sites who are paid for advertising, and drug manufactures of ED drugs”. None of this is true. Neither I nor any of my colleagues who publish peer-reviewed science have any “lobbyist” efforts. These conspiracy theories appear promoted to support her own books and profit her therapy practice.

Notice how Prause lied, saying that Sprout’s comment was about Prause and unnamed colleagues – and not, as Sprout actually wrote, about the billions made by “free pornography sites” (most owned by wealthy Mindgeek) and “drug manufacturers of ED drugs”. In short, this is not a legitimate complaint; it’s simply harassment.

Prause’s second complaint to Washington

Unsatisfied with Washington’s dismissive response, and angry that her duplicity in filing a groundless complaint against Sprout was made public on this page, Prause filed a second complaint against Sprout. Prause falsely claimed she had “whistleblower status.” The State again disagreed, and Washington again released the related correspondence to Sprout:

Update (6-8-18): The “implementation version” of the ICD-11 (the World Health Organization’s International Classification of Diseases – the world’s most widely used medical diagnostic manual) is now out (as of June, 2018). Its mental-health-expert authors have included a diagnosis that can be used to diagnose anyone suffering from compulsive sexual behavior (including sexual behavior addictions) called “Compulsive Sexual Behavior Disorder.”

Prior to the release of the “implementation version, ” a beta draft of the ICD-11 was also put online, and made available for interested parties to comment on. (A simple sign-up is needed to view and participate.) Note: Prause has posted more comments in the beta-draft comment section than everyone else combined. In the comments section under this new proposal, Prause attacks Staci Sprout, falsely claiming that Sprout “is under continued investigation” by the State of Washington. In fact, as explained and documented above, Washington summarily dismissed both of Prause’s baseless complaints.

Currently, there is an active scientific discussion about whether compulsive sexual behaviour disorder can constitute the manifestation of a behavioural addiction[5]. For ICD-11, a relatively conservative position has been recommended, recognizing that we do not yet have definitive information on whether the processes involved in the development and maintenance of the disorder are equivalent to those observed in substance use disorders, gambling and gaming[6]. For this reason, compulsive sexual behaviour disorder is not included in the ICD-11 grouping of disorders due to substance use and addictive behaviours, but rather in that of impulse control disorders. The understanding of compulsive sexual behaviour disorder will evolve as research elucidates the phenomenology and neurobiological underpinnings of the condition[7].

Anyone who considers the proposed disorder itself can see that it is intended to encompass sexual behavior addicts by whatever label.

Not so, but before we get to the truth it’s worth noting that her claim is very bold indeed, as 3 Prause studies on porn users failed to control for much of anything, including screening to establish that they were addicted to porn (Prause et al., 2013, Steele et al., 2013, Prause et al., 2015). In fact, these 3 Prause studies chose to ignore numerous standard exclusion criteria normally employed in addiction studies, such as psychiatric conditions, other addictions, psychotropic medications, drug use, other compulsions, depression, religiosity, age, sexuality, gender, etc.

We used the following exclusion criteria for PHB and control participants: age over 35 or under 18; other addictions such as alcoholism or gambling addiction, previous or current psychiatric, neurological, and medical disorders, homosexuality, currently using medication, a history of serious head injury, and general MRI contraindications (i.e., having a metal in the body, severe astigmatism, or claustrophobia).

To identify comorbid tendencies among subjects with PHB, the Beck Depression Inventory (BDI) (Beck et al., 1996), Beck Anxiety Inventory (BAI) (Beck and Steer, 1990), and Barrett’s Impulsiveness Scale II (BIS-II), as adapted by Lee (1992) were administered. The score of BIS-II was used as a covariate to remove the effects of impulsivity. The BIS-II consists of 35 questions with dichotomized ‘‘yes” (1) or ‘‘no” (0) answers. The total score ranges from 0 to 35, with higher scores indicating greater levels of impulsivity. Information about the demographic and clinical characteristics of all participants is presented in Table 1.

Mike South adult industry blog, the premier destination for adult industry news since 1998. Mike South was a small-time porn producer, who won two AVN awards, turned adult news blog pioneer. South was cited on a host of major news sites, and Gawker.com acknowledged him as “the gonzo king of porn gossip”.

In her defamatory piece, she knowingly, falsely stated that,

[Gary Wilson] claims to have been a “professor in Biology”. In reality, he was supposed to be an undergrad instructor, not a professor, for a lab section at Southern Oregon University. He was fired without pay immediately before completing even a quarter.

In truth, Gary was an Adjunct Instructor at Southern Oregon University and has never claimed to be a professor (although careless journalists and websites – including a now-defunct webpage – have assigned him an array of titles in error).

He taught at Southern Oregon University on two occasions. He was never “fired,” as can be seen from the employment documents beneath this paragraph. Gary also taught anatomy, physiology and pathology at a number of other schools over a period of two decades, and was certified to teach these subjects by the education departments of both Oregon and California.

——————————————————-

Below is the “un-redacted” copy of the document Prause posted on several websites. Prause claimed it meant that Gary was terminated, when it actually meant “terminate paychecks” as Gary had to resign due to a medical emergency. The Prause versions redacted the COMMENTS section, where SOU stated that Gary resigned due to a health issue.

Furthermore, Gary receives no compensation from the charity to which his proceeds from his book go. His position as Research Officer is an honorary (volunteer) one. Nor does he serve on the Board of the charity or otherwise determine how it disburses its funds.

In addition to placing the redacted employment document and associated libelous statements on a porn industry site, Prause used Quora and Twitter to spread her lies. In doing so, Prause was banned from Quora, and suspend by Twitter. See these two sections from the “Prause page”:

Gary also hopes that Dr. Prause will quit libeling and harassing him and others. Although this new instance of libel (her false claim that Gary was fired) isn’t as shocking as her libelous claim that she has a no-contact court order against him, it is equally untrue.

Perhaps it is time for Dr. Prause to grow up and behave like the professional she claims to be.

PS: Southern Oregon University confirmed that Nicole Prause was the only one who sought these records. Email below:

Prause’s usual partner in targeted harassment, David Ley, also falsely stated that Gary Wilson was fired from Southern Oregon university (Ley later deleted the tweet):

Both Prause and Ley are obsessed cyberstalkers.

Another libelous tweet by Ley, promoting the Mike South article (that was later removed from Mike South’s website):

Prause tweeted several times, linking to her libelous Quora article (the article that got her banned from quora – see next section):

On March 3rd 2018, Nicole Prause posted a defamatory article on Quora: https://www.quora.com/What-do-you-think-about-your-brain-on-porn-movement/answer/Nicole-Prause. In her piece, Prause posted redacted copies of Gary Wilson employment records and knowingly, falsely stated that Southern Oregon University had fired Wilson. On the same day she publsihed her Quora article, Prause posted ten more demeaning and untruthful comments about co-author Wilson and his work, all containing a link to her defamatory piece:

Wilson reported Prause to both Quora and Twitter for violation of terms of service and harassment. Both acted upon Wilson’s complaints, removing his employment document and Prause’s false interpretation of it. Confirmation of Quora acting on Wilson’s complaint (not the first violation for harassing Gary Wilson):

In her defamatory articles, tweets, and Quora posts Prause has knowingly and falsely stated that Gary Wilson claimed to be “professor in biology” or a “neuroscientist”. Gary was an Adjunct Instructor at Southern Oregon University and taught human anatomy, physiology & pathology at other venues. Although careless journalists and websites have assigned him an array of titles in error over the years (including a now-defunct page on a website that pirates many TEDx talks and describes the speakers carelessly without contacting them) he has always stated that he taught anatomy & physiology. He has never said he had a PhD or was a professor.

Below is the screenshot Prause posts to “prove” that Gary Wilson has misrepresented his credentials (again, the Gary Wilson page no longer exists). Note: Until Prause produced her “proof,” Gary had never seen this site and has never communicated with its hosts, never uploaded the page in question and never removed it. Thus he certainly never provided a bio, or claims of “professorship.”

Gary taught at Southern Oregon University on two occasions. Gary also taught anatomy, physiology and pathology at a number of other schools over a period of two decades, and was certified to teach these subjects by the education departments of both Oregon and California. Gary does not seek speaking engagements and has never accepted fees for speaking. Moreover, YBOP accepts no ads, and the proceeds from Gary Wilson’s book go to a registered charity.

As you can see in the 3 preceding sections, Prause posted Gary Wilson’s Southern Oregon University employment records on Twitter, Quora, and an adult website. In her defamatory posts, Prause knowingly and falsely stated that Gary Wilson was fired and had never previously taught at Southern Oregon University. Wilson was not fired and had previously taught at SOU. These violations resulted in Prause being permanently banned from Quora and suspended from Twitter, with a warning. Wilson sent the adult website (MikeSouth) a DMCA takedown notice, which resulted in the Prause “article” being deleted. (deleted url: http://mikesouth.com/scumbags/dr-nicole-prause-destroys-yourbrainonporn-dont-fall-22064/).

In a clear reprisal for having had her impulsive plans foiled, Prause filed her first DMCA takedown request with my website host on 3/29/2018. For those who may not know, DMCA stands for Digital Millennium Copyright Act. A DMCA takedown notice is used to have copyrighted materials removed from a website. Prause filed a DMCA takedown as a backdoor way to have this page chronicling her harassment and defamation removed or gutted. Prause is claiming that screenshots of her tweets are copyrighted material. Tweets are generally not copyrightable, and hers are not. Every day thousands of websites and countless Twitter users post screenshots of tweets. A portion of Prause’s first DMCA complaint:

It’s disturbing that Prause claims to be a victim here, as I have documented multiple instances of her harassing myself and others – including researchers, medical doctors, therapists, psychologists, former UCLA colleagues, a UK charity, men in recovery, a TIME magazine editor, several professors, IITAP, SASH, Fight The New Drug, the academic journal Behavioral Sciences, and the head of the academic journal CUREUS: https://www.yourbrainonporn.com/nicole-prauses-pdf-her-span-lab-website

As for other places where Prause name appears, YBOP contains about 10,000 pages, and it’s a clearinghouse for nearly everything associated with Internet porn use and its effects on the user. Nicole Prause has published multiple studies about porn use and hypersexuality, and by her own admission, is a professional “debunker” of porn addiction and porn-induced sexual problems.

A Google search for “Nicole Prause” + pornography” returns about 11,000 pages. She’s quoted in hundreds of journalistic articles about porn use and porn addiction, in addition to her research related to pornography use. She’s on TV, radio, podcasts, and YouTube channels claiming to have debunked porn addiction with a single (heavily criticized) study. So Prause’s name is inevitable on a site like mine, which functions as a clearinghouse for research and news associated with Internet porn’s effects. YBOP also critiques other questionable research on porn and related subjects. These critiques are not personal, but rather substantive.

This DMCA take-down request is just the latest in a long string of harassment incidents by Prause. Dr. Prause has tweeted about me nearly 100 times, while I never tweet about her (other than correcting a few of her lies). Prause has used dozens of fake usernames to post comments about me on porn recovery forums (https://www.yourbrainonporn.com/nicole-prauses-pdf-her-span-lab-website#ybr). Prause has created an amazon AWS page to libel and harass me and many others (https://s3-us-west-1.amazonaws.com/weilerdefamation/PressRelease_DefamationBySenatorWeiler.txt).

Thank you for your attention.

Gary Wilson

After a few back and forths with Wilson the website host suggested, “that the two of you can work out whatever it is that is going on here“. Gary Wilson responded:

Dear ______

Thank you for your message. Dr. Prause already has my contact information, which you are welcome to provide her again. However, she has demanded that I not contact her directly (even though I have never initiated direct contact with her). Unfortunately, therefore, I’m not sure how it would be possible for us to exchange views or reach an accord in the way you propose.

My website is a clearing house for news related to claims about porn’s effects. It is my understanding, based on legal advice, that Tweets are generally not copyrightable, nor are images of them protected by the DMCA. There are no other images relating to Dr. Prause that I’m aware of on YBOP.

Dr. Prause’s behavior and biases, as documented by her Tweets, are essential reading for anyone trying to understand the politics currently influencing the study and reporting of internet porn’s effects. Thus, without solid reason for their removal, they need to remain on YBOP.

I regret that Dr. Prause has tried to involve [you] in her latest harassment efforts.

Best regards,

Gary

The YBOP hosting service responded by “closing the ticket”:

Greetings,

Thank you for the update on this issue. We’ll pass along your contact email address. I hope this leads to an amicable solution for both of you.

At this time we consider this Copyright Infringement matter resolved. I have set this ticket to automatically close in 96 hours while we continue to monitor for additional complaints.

If you have any questions please let me know.

Not to be deterred, Prause acquired the services of DMCA Defender.com, who filed a second DMCA takedown request on April 17th, 2018. Once again, DMCA Defender claimed that screenshots of tweets are somehow copyrighted. They provided no authority to support the assertion, but did provide the urls of each screenshot. Gary Wilson, once again, responded to Prause’s harassment:

Dear _______

In case you need details for your records, I see that my harasser, Nicole Prause, has now hired a company to assist her in spurious DMCA takedown requests. Prause is falsely claiming that screenshots of her tweets and Facebook comments are copyrighted material. Nearly all of the screenshots the company complains of can be found on the YBOP page that documents Prause’s harassment of myself and others – including researchers, medical doctors, therapists, psychologists, former UCLA colleagues, a UK charity, men in recovery, a TIME magazine editor, several professors, IITAP, SASH, Fight The New Drug, the academic journal Behavioral Sciences, and the head of the academic journal CUREUS. See – https://www.yourbrainonporn.com/nicole-prauses-pdf-her-span-lab-website

As stated in response to Prause’s previous DMCA attempt, my website is a clearing house for news related to claims about porn’s effects. It is my understanding, based on legal advice, that Tweets are not copyrightable, nor are images of them protected by the DMCA. With this request, Prause is attempting to remove evidence of her harassment, cyber-stalking and defamation. Unless the law itself changes, the screenshots need to remain.

This DMCA take-down request appears to be the latest in a long string of harassment incidents. Dr. Prause has tweeted about me nearly 100 times, while I never tweet about her (other than correcting a few of her lies). In fact, Prause attacked me yet again on twitter yesterday.

Prause has used dozens of fake usernames to post comments about me on porn recovery forums

Just prior to Prause‘s first DMCA takedown attempt, she placed my employment records from Southern Oregon University on several venues, including Twitter, Quora, and an adult industry website. Prause falsely claimed that I was fired (I wasn’t), and that I had never before taught at SOU (I had). All explained here:

In the end Wilson’s website host closed both cases, finding no merit in Prause’s DMCA take-down requests. Note: At the same time Prause was attempting her bogus DMCA takedowns, she also deleted hundreds of the tweets were she harassed, libeled, or bullied many individuals and organizations named on this page.

UPDATE: October, 2018 – Prause attempts a third DMCA takedown

On October 10th, 2018 an agent representing Nicole Prause filed a 3rd DMCA takedown request with my website host. The agent requested that several screenshots of Prause tweets be removed from this page. Below is Gary Wilson’s email to his web-host

The current complaint is by an agent for Nicole Prause and has been dealt with before. See this Linode ticket from 6 months ago: ————————————————–

Please re-visit that ticket. This is Dr. Prause’s third unfounded attempt to have evidence of her tweets removed from my website. After she wrote you the first time and failed to achieve her objective, she hired a company to make a request. Now, she has second company attempting a spurious DMCA takedown.

As explained in two previous Linode tickets, Nicole Prause has been harassing and defaming many people, including me, for the past 6 years. In response to Dr. Prause’s widespread harassment I have created the following page to catalog (and refute) her libelous statements and false assertions: https://www.yourbrainonporn.com/nicole-prauses-pdf-her-span-lab-website

The current ticket submitted by Dr. Prause, or her agent, is once again claiming that screenshots of her defamatory tweets are covered by the DMCA. As stated 6 months ago, it is my understanding, based on legal advice, that tweets are not copyrightable; nor are images of them protected by the DMCA. Dr. Prause’s behavior and biases, as documented by her tweets, are essential reading for anyone attempting to understand the politics currently skewing the study and reporting of internet porn’s effects. Thus, without solid reason for their removal, they need to remain on YBOP.

Sincerely,

Gary Wilson

In the end Wilson’s website host closed this 3rd case, finding no merit in the agent’s DMCA take-down requests.

Nicole Prause attacked Cureus on Twitter over a paper that it had merely corrected (slightly). Prause claimed that Cureus is a predatory journal which engages in fraud. Both claims are false as predatory journals always charge for publication and are not PubMed indexed. Cureus does not charge authors for publishing, and it is PubMed indexed. Prause, as expected, provided no examples of Cureus engaging in fraud.

Next, John Adler, MD stepped in to refute Prause’s claims. She then falsely accused him of violating a non-existent no-contact order, blocked him on Twitter, and phoned in a spurious complaint of harassment to the Stanford’s Dean’s Office.

As they often do, Ley and Prause team up to defame and harass those they disagree with. This time they play twitter tag in a pre-planned attack on Gary Wilson, Don Hilton, and Mary Ann Layden. We know it was a pre-planned event as the “evidence” they both tweeted was in a concurrent email with other untruths about Wilson sent from Prause to MDPI (Ley was cc’d on the email).

In Ley’s first tweet he sets things up for Prause by falsely stating that Chris Sevier was the “creator of porn is public health crisis legislation.” In reality, Utah was the first state to pass a resolution about porn and Sevier had nothing to do with it. Ley’s so-called proof is screenshot from this incredibly long page containing four years of court filings full of allegations in the case, Sevier v. Apple inc.

Why did David Ley choose this random excerpt about gays from Sevier’s January, 2014 court filing? So he and Prause could falsely assert that Wilson, Hilton, and Layden are anti-gay crazies.

Before we go any further, it must be mentioned that Chris Sevier seems to be universally believed by all who experience a brush with him to be a mentally unstable attention-seeker who chronically lies and harasses individuals and organizations associated with the so-called “anti-pornography movement.” Incidentally, “crazy” supporters are a time-honored strategy for tarnishing and impeding a cause.

The second matter relates to the author of the HTPA. The bill (sans resolution language) was developed by Chris Sevier, also known as Chris Severe. We have had a difficult relationship with Mr. Sevier over the last several years, to say the least. We have not found him trustworthy in our past dealings and therefore cannot rely on his assertions that those groups and those legislators that he claims are supporters of HTPA are actually in support. That is because, in the past, Sevier has falsely represented that our organization and NCOSE President Patrick Trueman and NCOSE Executive Director Dawn Hawkins are in support of his work. We have demanded that Sevier stop using our names.

In 2015, the office of a United States Senator alerted us to the fact that Sevier was promoting a version of the HTPA at the U. S. Capitol and was representing to U. S. Senate offices that Patrick Trueman was an author of the bill. This was false. A key legal assistant with that senator’s office also said that Sevier was visiting other senate offices claiming that his boss, the senator, was supporting the legislation, which was also false.

Several organizations have contacted us over the past couple years to complain that Sevier was also using their names without authorization and some of those organizations have complained that he was threatening them with legal sanctions when they refused to support him and his work. Several organizations have contacted us over the past couple years to complain that Sevier was also using their names without authorization and some of those organizations have complained that he was threatening them with legal sanctions when they refused to support him and his work.

In 2014, our general counsel had to write a cease and desist letter to Sevier demanding that he cease threatening our organization on various matters and reminding him that as a lawyer he is bound be definitive rules of professional responsibility.

In 2016 Sevier sued the state of Utah following the passage of the above-mentioned resolution developed by our office which declares pornography to be a public health crisis. The lawsuit was ostensibly over the issue of filters (a copy of the complaint is here). It included an extended footnote, part of which we are including here, which attacks NCOSE’s President Patrick Trueman and Executive Director Dawn Hawkins in bizarre terms…..

Very important set of facts: Don Hilton and Mary Ann Layden are on the board of directors of NCOSE and both regularly present at NCOSE conventions and NCOSE-related gatherings. How likely is it that they would be furthering Sevier’s “cause” by contradicting the position taken by NCOSE against Sevier?

With Ley’s set-up, Prause next tweets that Sevier claimed Gary Wilson and “these experts” were ready to testify:

No way! Hilton, Layden and Wilson never agreed to testify for Sevier, and certainly never agreed to testify that “all gay people are sex addicts.” It’s true that “Severe” emailed Gary Wilson in 2014. In Wilson’s response he suggested Severe visit his website for information. Wilson never agreed to testify, and did not respond to further emails from Severe. Don Hilton was asked if he had ever communicated with Sevier/Severe. He said he had not. Put simply, Sevier, and the Prause-Ley tag team, are lying.

With nothing but lies to back him up, Ley caps off the tag-team twitter like this:

Both Prause and Ley are obsessed cyberstalkers, with 300 tweets or more about Gary Wilson alone. Their assertions here are reprehensible and disgusting, yet fully in character.

In an earlier section we recounted Prause’s harassment of MDPI and its journal Behavioral Sciences. We also chronicled Prause’s long history of employing multiple fake usernames on Wikipedia (which violates its rules) to harass many of the individuals or organizations listed on this page. For example:

Prause’s latest Wikipedia barrage occurred from May 24th to the 27th and involved at least 6 fake usernames (called “sock-puppets” in Wikipedia jargon). The following links take you to all the edits by these particular usernames (“user contributions”):

The first four usernames edited the MDPI Wikipedia page, while 3 of the 6 edited the Nofap Wikipedia page, the Sex Addiction page and the Pornography Addiction page. All 3 pages are obsessions of Prause. Even Wikipedia recognized the usernames as belonging to the same person because all the names were banned for “sock-puppetry.” We can be sure it was Prause editing the MDPI page because:

1) The most recent batch of emails between MDPI and Nicole Prause started on May 22, with MDPI notifying all involved that one minor technical correction and an editorial would be forthcoming. This enraged Prause who responded with a string of demands and threats, followed by false accusations and personal attacks.

I have images that verify each of the claims (e.g., email from the publisher, email from the listed editor, etc.). RetractionWatch and other outlets are considering writing reviews of it as well, but I cannot be sure those will materialize. How is best to provide such evidence that verifies the claims? As embedded image? Written elsewhere with images and linked?

Let’s provide a few examples of the “NeuroSex” edits (lies) related to Gary Wilson and to Park et al., 2016 – followed by Wilson’s comments:

In 2016, another MDPI journal, Behavioral Sciences, published a review paper claiming pornography caused erectile dysfunction. Six scientists independently contacted MDPI concerned about fraud and other issues in the article, initiating an independent review by the Committee on Publication Ethics (COPE). COPE recommended retracting the article.[31] The listed paper editor, Scott Lane, denied having served as the editor. Thus, the paper appears not to have undergone peer-review. Further, two authors had undisclosed conflicts of interest. Gary Wilson’s association with The Reward Foundation did not properly identify it as an activist, anti-pornography organization. Wilson also had posted extensively in social media that the study was “by the US Navy”, although the original paper stated that it did not reflect the views of the US Navy. The other author, Dr. Andrew Doan, was an ophthalmologist who ran an anti-pornography ministry Real Battlefield Ministries, soliciting donations for their speaking.[32] Further, the Committee on Publication Ethics determined that the cases were not properly, ethically consented for inclusion. MDPI issued a correction for some of these issues,[33] but has refused to post corrections for others to date as described by Retraction Watch.[31]

Several of the above lies debunked:

There were not 6 scientists – only Prause contacted MDPI.

My association with The Reward Foundation was fully disclosed from the beginning. As explained earlier, my affiliation with The Reward Foundation (TRF) was always clearly stated, both in the initial Behavioral Sciences article and in the recent correction (the original PubMed version). The purpose of the newly published correction was to counter Dr. Prause’s incessant defamatory claims that I receive money from TRF, and that I make money from my book (my proceeds for which, in fact, go to the charity)

I posted that the paper involved 7 US Navy doctors. The Navy had no problems with my comments.

Dr. Andrew Doan is both an MD and a PhD (Neuroscience – Johns Hopkins), is the former of Head of “Addictions and Resilience Research” in the Department of Mental Health at the Naval Medical Center. (He has since been transferred and promoted, and has different responsibilities.) Doan has authored multiple papers on behavioral addiction/pathologies relating to technologies (in some cases with a co-author of the paper you have written about here). In short, he is a qualified senior author. Those other papers can be found here: https://www.ncbi.nlm.nih.gov/pubmed/?term=doan+klam. His non-profit, Real Battlefield Ministries (RBM), did not discuss pornography prior to publication of the paper. Even if RBM had presented on pornography it would not have been a conflict of interest.

As described above, COPE’s decision was hypothetical and did not apply to our paper as the US Navy doctors more than complied with their Naval Medical Center – San Diego’s IRB consent rules. The Naval Medical Center San Diego’s IRB policy does not consider case reports of less than four patients in a single article to be human subject research and does not require the patients to consent to inclusion in an article. Although the researchers were not required to obtain consent, for two cases, verbal and written consents were obtained. In the third case where anonymity was unlikely to be compromised, no written consent was obtained. Incidentally, at Dr. Prause’s insistence, after the paper was published, the actions of the Navy co-authors with respect to this paper were thoroughly reviewed in an independent Navy investigation. Result? I have a copy of the official report by a Navy lawyer affirming that the co-authors complied with all the IRB’s rules.

——————————————

NeuroSex edit #2: In 2015, the MDPI journal ”[[Behavioral Sciences (journal)|Behavioral Sciences ]]” published a paper ”Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports”. It was widely promoted during political attempts in the USA to define pornography as a public health hazard. However, it was soon discovered that many fraudulent statements appeared in the paper, often claiming the opposite of what a cited study had described

Gary Wilson comment:

To begin with, NeuroSex (Prause) got the publication date wrong: our paper was published in August, 2016, not in 2015. Second, our paper was not widely promoted. Third, no fraudulent statements were made and we cited all references correctly. A bit of background is in order.

Pre-MDPI history

The story of Prause’s efforts relating to the paper that was ultimately published as Park et a l., 2016 actually begins before the involvement of MDPI and Behavioral Sciences. An earlier, much shorter version of the paper, with the same authors and author affiliations as it had when later submitted to Behavioral Sciences, was first submitted to Yale Journal of Biology and Medicine (YJBM). It’s worth reviewing certain conduct in connection with this paper when it was under consideration by YJBM.

One of the 2 reviewers of the paper gave it a scathing review with 70+ criticisms, and it was duly rejected. Around the time that YJBM rejected the paper, a “Janey Wilson” began harassing my book publisher, Commonwealth Publishing, and the registered charity to which I donate all of my share of my book’s proceeds (recounted in this section). I am the author of Internet Pornography and the Emerging Science of Addiction.

Note: The submission to YJBM was the only place my affiliation with the charity, The Reward Foundation (TRF), could be found, as it was nowhere public. In other words, apart from the Board of TRF and myself, only the YJBM editor and its two reviewers knew about this affiliation. And yet, “Janey” claimed to have evidence of this affiliation, and used my affiliation to fabricate various allegations of wrongdoing by TRF and me.

Later, Dr. Prause submitted her scathing YJBM review with 70+ criticisms to a regulatory board (as part of an effort to have the published paper retracted), thus confirming she had indeed provided the YJBM with an unfavorable review of the paper. (Further evidence that she was a YJBM reviewer turned up during the Behavioral Sciences submission process, as recounted below.) Incidentally, Prause’s actions are a clear violation of COPE’s rules for peer reviewers (Section 5 of the “Guidelines on Good Publication Practice”), which require reviewers to keep confidential anything they learn through the review process.

YJBM was informed of (1) the harassing behavior engaged in by “Janey,” (2) “Janey’s” possible true identity, and (3) the fact that “Janey” may have violated COPE’s rules for peer reviewers by making public confidential information about me.

The paper was promptly accepted by YJBM…and then not published in that journal after all, due to the journal’s decision that it was too late to make the requested revisions and still meet the print deadline for YJBM’s special “Addiction” issue.

Behavioral Sciences

A revised and updated version of the paper was then submitted to the journal Behavioral Sciences. After a few rounds of reviews and further restructuring it was accepted as a review of the literature, with case studies. Its final form was quite different from the original YJBM submission.

During this process, the paper was reviewed by no fewer than 6 reviewers. Five passed it, some with some suggested revisions, and one harshly rejected it (It was Prause again, as she later revealed).

Phase one of this process unfolded as follows: The paper was reviewed twice, one of them a harsh rejection, one favorable. Puzzled by the harsh rejection, Behavioral Sciences sent the paper out for review to 2 other reviewers. These reviewers passed the paper. Behavioral Sciences cautiously rejected the paper but allowed the authors to “revise and resubmit.” As part of this process, the authors were given all of the comments by the reviewers (but not their identities). The reviewers’ concerns were thoroughly addressed, point by point (available upon request).

From these comments, it became evident that the “harsh reviewer” of the Behavioral Sciences paper had also reviewed the paper at YJBM.About a third of the 77 points raised did not relate to the Behavioral Sciences submission at all.They referred to material that was only present in the earlier version of the paper, the one that had been submitted to YJBM.

In other words, the harsh reviewer had cut and pasted dozens of criticisms from a review done of an earlier iteration of the paper at another journal (YJBM), which no longer had any relevance to the paper submitted to Behavioral Sciences! This is highly unprofessional. Moreover, Prause eventually revealed herself as the author of these criticisms in her complaint to the medical boards (see above), in which she shared her YJBM review of the obsolete version of the paper. (Apparently, she never realized the YJBM paper had been accepted by YJBM once her review was disqualified.)

Incidentally, when Prause was asked to review the paper at Behavioral Sciences she apparently did not reveal that she had already reviewed the paper at another journal. It would have been standard reviewer etiquette to reveal her earlier review effort.

Let me summarize Prause’s multiple objections to our paper. Again, 25 or so of them had nothing whatsoever to do with the Behavioral Sciences paper Prause had been asked by Behavioral Sciences to review. These items referred to its first submission at YJBM. This alone should disqualify the entire review from further consideration.

Yet, we carefully combed through each comment looking for any useful insights, and wrote a comprehensive response to all 77 comments for Behavioral Sciences and its editors. Almost all of the remaining 50 critical comments were either scientifically inaccurate, groundless, or were simply false statements. Some were repetitive. In short, while reviewers’ comments always improve any paper to some degree, there really wasn’t the need to “fix” much of the paper itself in light of Prause’s comments. What we did do was strengthen the paper itself with 50 more citations, lest other readers make any of the same errors she had.

The paper was rewritten and revised. Next, two more reviewers reviewed and passed it with various suggestions, including a suggestion to restructure it as a “review with case studies.” Satisfied that all legitimate concerns had been addressed, Behavioral Sciences published the paper.

Immediately after publication in August, 2016 Prause insisted that MDPI retract Park et al., 2016. The professional response to scholarly articles one disapproves of is to publish a comment outlining any objections. Behavioral Sciences’s parent company, MDPI, invited Prause to do this. She declined. That’s right, Prause was given full opportunity to critique the paper in Behavioral Sciences – and she ran the other way.

Instead she unprofessionally turned to threats and social media (and most recently the Retraction Watch blog) to bully MDPI into retracting Park et al. In addition, she informed MDPI that she had filed complaints with the American Psychological Association and the doctors’ medical boards. She also pressured the doctors’ medical center and Institutional Review Board, causing a lengthy, thorough investigation, which found no evidence of wrongdoing on the part of the paper’s authors.

Prause concurrently complained repeatedly to COPE (Committee on Publication Ethics). COPE finally wrote MDPI with a hypothetical observation relating to (Prause’s narrative about) consents obtained for the case studies in the paper, and a question about retraction. MDPI thoroughly re-investigated the consents obtained by the doctors who authored the papers, as well as US Navy policy around obtaining consents. Written consents had been obtained for the two extensive case studies, and the third case study involved so little identifying information that a written consent was deemed unnecessary. On this basis, MDPI declined to retract the paper.

May, June 2018 – In emails, in the ICD-11 comments section, and on Wikipedia, Prause and her sockpuppets falsely claim that Wilson received 9,000 pounds from The Reward Foundation

Starting in May, 2018 Prause added a new wrinkle to her claims, namely that, “The Reward Foundation (RF) paid Wilson 9,027 pounds.” This is completely false, even though there’s absolutely nothing wrong with Wilson being paid by anyone for anything. The crazy part is that Wilson donates the proceeds from his book to the RF. In other words, Prause is claiming that Wilson gives money to the RF so they can give it back to him at a later date. Why Wilson would choose to play trans-Atlantic ping pong with his money in this way, Prause has yet to explain. Bottom line: Prause is lying.

This all started with Prause’s email to journal publisher MDPI, COPE, David Ley, Neuroskeptic, Adam Marcus & Ivan Oransky of Retraction Watch (and others) that, based on the charity’s recent public filing (with a name redacted, as is standard), expense reimbursements paid to a charity officer were in fact paid to Wilson. Prause, wrongfully assumed (and publicized) that Wilson’s name was behind the redaction when it wasn’t!

I request that any correction include this financial COI, or time be allotted to properly demonstrate that this was not a financial conflict of interest.

Nicole Prause, Ph.D. Liberos

Two days later, one of Prause’s seven wikipedia sockpuppets attempted the following edit on MDPI Wikipedia page, assigning Wilson a fabricated, defamatory reason for receiving the money (that he had never, in fact, received):

NeuroSex linked to a redacted document, claiming that Gary Wilson was paid 9,000 pounds by Scottish charity The Reward Foundation. Prause and her sockpuppet NeuroSex did not check the facts. Wilson has never received any money from The Reward Foundation. Gary Wilson forwarded Prause’s claim to Darryl Mead, Chair of The Reward Foundation. His response:

This is a reference to our 2016-17 Annual Accounts. A version of the accounts with identity redaction was published by the Office of the Scottish Charity Regulator and can be downloaded at https://www.oscr.org.uk/search/charity-details?number=SC044948#results, copy attached. This redaction process is done by OSCR without input from the named charity.

The relevant section with redaction reads as per this screen shot.

The individual referred to in C6 is Darryl Mead, the Chair of the Reward Foundation. I am that person and I made the claim for reimbursement of travel and other costs.

The original document reads as follows:

There is no reference to Gary Wilson in any part of the expenditure for the Reward Foundation because there were no payments to him.

With best wishes,

Darryl

In summary, Prause falsely accused Wilson of receiving funds from The Reward Foundation for a fabricated purpose. She then publicized this falsehood to MDPI, COPE, RetractionWatch, and others, using the redacted document she submitted. Then sockpuppet NeuroSex attempted to post these lies to Wikipedia, which failed.

Update, 6-7-2018:

For no reason in particular, Prause posted a comment on the ICD-11 about Gary Wilson. [Would be readers must create a username to view comments.] In this comment Prause repeats the above lies:

Prause not only repeated her original lie, she added several more of her usual lies about Wilson (all debunked on this very page). Prause also says that she has filed a second complaint against Staci Sprout with Washington. This part is true, as second harassing complaint was filed against Sprout and immediately dismissed.

In the 5 years since Prause’s cyber-aliases started claiming that Wilson was reported to the police, Prause has failed to provide any documentation of her purported police reports. the truth? As for the LAPD & UCLAPD, both have said that Prause never filed anything with their departments. In October, 2018 Gary Wilson filed a freedom of information request with the FBI and the FBI confirmed that Prause was lying: no report has ever been filed on Wilson. See – November, 2018: FBI affirms Nicole Prause’s fraud surrounding defamatory claims. Gary Wilson has been patiently waiting since July, 2013 (1) to discover what exactly he was reported for, (2) to be contacted by “the authorities.” Neither has occurred because Prause is lying.

Over the next few days Nicole Prause posted 3 more libelous comments on the ICD-11 attacking Gary Wilson and continuing to assert falsely that he is a paid employee of The Reward Foundation. Darryl Mead, the Chair of The Reward Foundation, eventually responded:

As described above, from May 24th to the 27th, 2018 Prause employed six fake usernames to edit the Wikipedia pages of her ongoing obsessions: MDPI, Nofap, Sexual Addiction, and Pornography Addiction. Even though Prause’s main target was MDPI, two of her sock-puppets took the time to attack Nofap, with edits and defamatory comments. As she has done in Twitter comments and in personal attacks on Alexander Rhodes, Prause called members of Nofap dangerous misogynists.

03:28, 24 May 2018 (diff | hist) . . (+379)‎ . . Pornography addiction ‎ (→‎Support groups: NoFap community has recently raised security concerns paralleling Incels and due to this paper discovering considerable misogynist attacks in NoFap. I suggest removal, but at least should warn people community is not safe.)

The length of the longest streak participants performed before taking part in the survey correlates with time preferences. The second survey will answer the question if longer periods of abstinence render participants more able to delay rewards, or if more patient participants are more likely to perform longer streaks.

Longer periods of abstinence most likely cause less risk aversion (which is good). The second survey will provide the final proof.

Personality correlates with length of streaks. The second wave will reveal if abstinence influences personality or if personality can explain variation in the length of streaks.

Results of the Second Wave – Main Findings

Abstaining from pornography and masturbation increases the ability to delay rewards

Participating in a period of abstinence renders people more willing to take risks

Abstinence renders people more altruistic

Abstinence renders people more extroverted, more conscientious, and less neurotic

Unfortunately, Prause’s deletion of the Sproten study has not yet been reversed, and the Kris Taylor paper remains. More evidence that Wikipedia editors game the system, and sockpuppets rule.

The previous two sections chronicle Prause’s Wikipedia-based attacks on two of her favorite targets: MDPI and Nofap. In Prause’s recent 4-day Wikipedia blitz three of her sockpuppets edited two other objects of her disdain: the Wikipedia pages on “Sexual Addiction” and “Pornography Addiction” (which her numerous sockpuppets had previously edited over the years). In her many edits Prause attacks familiar targets such as Dr. Todd Love, Fight The New Drug, therapist Staci Sprout, Dr. Patrick Carnes, CEO of MDPI, the American Society for Addiction Medicine, and a protein – DeltaFosB.

Here we present selected edits and remarks from three sockpuppets, followed by our comments:

Comment: Once again, Prause is attacking therapist Staci Sprout, who Prause harassed and defamed in a groundless complaint filed with Washington State Dept. of Health. The State of Washington dismissed the empty complaint (without an investigation) and closed the case. Prause has also attacked Staci Sprout on Twitter and on the ICD-11 comment page for “Compulsive sexual behaviour disorder.”

02:16, 25 May 2018 (diff | hist) . . (-172)‎ . . Sexual addiction ‎ (→‎Controversy: info-graphic was created by Mormon group Fight The New Drug, an anti-pornography organization. Not neutral and does not accurately reflect history, such as including individuals with no field influence

02:20, 25 May 2018 (diff | hist) . . (-3,460)‎ . . Sexual addiction ‎ (→‎Mechanisms: Large section about FOSB made no mention of link to sex and had about 7 broken links (numbers clearly pasted from some other source, not properly attributed))

03:16, 24 May 2018 (diff | hist) . . (-1,180)‎ . . Pornography addiction ‎ (→‎Diagnostic status: Todd Love is described as an “addiction researcher”. He has zero research training and no data publications. He represents another false appeal to authority to create a false narrative. The reference describing him falsely as a scientist is removed.) (Tag: references removed)

Comment: Here Prause’s sockpuppets told 2 (more) bare-faced lies. First, the American Society for Addiction Medicine is hardly a fringe group as its members include 3,000 medical doctors who specialize in addiction treatment. ASAM has been around longer than the DSM. Second, ASAM never stated that “tanning addiction” exists. Just another lie. What angers Prause is that America’s top addiction experts at ASAM released their sweeping new definition of addiction in 2011. ASAM’s definition of addiction explicitly stated that sexual behavior addictions exist and must be caused by the same fundamental brain changes found in substance addictions. From the ASAM FAQs:

QUESTION: This new definition of addiction refers to addiction involving gambling, food, and sexual behaviors. Does ASAM really believe that food and sex are addicting?

ANSWER: The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. … This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. …Food and sexual behaviors and gambling behaviors can be associated with the ‘pathological pursuit of rewards’ described in this new definition of addiction.

The sockpuppet’s comments on the Sexual Addiction Talk Page perfectly mirror Prause’s usual baseless drivel about “sex addiction” being rejected, and that sex/porn addiction can be explained away by either high libido or shame:

Add first line to “is a proposed model” or “is an hypothesized model”. “Addiction” is a scientific model that has not been agreed on by any scientific body, so presenting “sex addiction” as “a state” misrepresents the state of the science, which largely has rejected this model (relative to, for example, impulsivity model, high drive model, social shame model, etc.). 71.196.154.4 (talk) 15:33, 5 June 2018 (UTC)

A Wikipedia editor asks Prause for reputable sources to support her claims:

In addition, TestAccount2018abc posts on the Sexual Addiction Talk Page, once again raging againts the new ICD-11 diagnosis of “Compulsive Sexual Behavior Disorder”. The Prause sockpuppet argues with regular editor Tgeorgescu (who is actually quite anti porn and sex addiction – but not extreme enough for Nikky): https://en.wikipedia.org/wiki/Talk:Sexual_addiction

Semi-protected edit request on 26 November 2018

Information about the ICD-11 draft was added, but did not include that (1) The ICD cannot be accepted as a diagnosis anywhere yet, and the earliest in the USA is 2022 and (2) the World Health Organization specifically stated that they did not find evidence that sex was addictive. Given that this article is “sex addiction”, that must be included for this to be accurate, otherwise it is misleading to people who do not know the differences between a compulsion and an addiction (there are many). “But the UN health body stops short of lumping the condition together with addictive behaviours like substance abuse or gambling, insisting more research is needed before describing the disorder as an addiction.” Dr. Geoffrey Reed, WHO [1]TestAccount2018abc (talk) 20:44, 26 November 2018 (UTC)

Sexual addiction is an umbrella concept, which people use in different meanings. The point you’re making is explained under Sexual addiction#ICD. Tgeorgescu (talk) 21:16, 26 November 2018 (UTC)

Cool down buddy, I’m not an anti-sex activist, through my edits I have decidedly opposed sexual pseudoscience, but I am also prepared to give the other side the benefit of the doubt when the matters aren’t settled yet. You have read too few of what I wrote inside Wikipedia and you’re jumping to conclusions. If that’s the way to treat your allies I wonder how you treat your enemies. So, yeah, I know that compulsion is different from addiction. However, this article is not only about sexual addiction, but about a lot of stuff. Instead of having ten different articles with roughly the same content, we have one article which covers them all. This is not hard to get from reading it. Tgeorgescu (talk) 17:01, 28 November 2018 (UTC)

This impression was based on a review of your bio, which has extensive commentary about your biblical beliefs, not your scientific background in this area. So the critique of the article and the likely source of the bias seems fair. The article already states in one place exactly what I suggest, your addition reverts back to mischaracterize again. I did not request a separate entry at any time, only that this entry be scientifically accurate. With your last addition, it is no longer scientifically accurate by my, or the World Health Organization’s, estimation. — Preceding unsigned comment added by 209.194.90.6 (talk)17:12, 28 November 2018 (UTC)

First, Wikipedia does not require editors to be experts/scientists, that’s a thing for Citizendium. Wikipedia requires editors to WP:CITEWP:SOURCES, that’s all: you have sources, you have everything, don’t have sources, don’t have anything. Second, editing Wikipedia is a cooperative enterprise. If I were the only one to write this article, I would write it differently, but since everybody can edit, I have to make allowance for their doubt. Third, the matter of sexual addiction vs. CSBD is not settled yet: ICD is not a diagnosis manual, it is a manual of codes, so that a French MD understands the diagnosis of a Mexican MD. There has been a discussion about adding TCM codes to ICD, but in fact WHO does not say that a specific code is a thing, so if TCM would be included in the ICD it would not mean that TCM got scientifically validated. Fourth, I have quoted a source (Ley), which says that ICD does not include sexual addiction, and I tried to briefly explain his point. Perhaps you might try to suggest a different wording, I’m all ears. Fifth, don’t cast aspersions based on insufficient data. More precisely, you did not bother to read my opinions, e.g. that in respect to mental health insurance money, DSM is king, not ICD, and since addictions got purged out of DSM there is unlikely to be a diagnosis of porn addiction (or sex addiction, for that matter). Tgeorgescu (talk) 21:10, 28 November 2018 (UTC)

Notice: in the above exchange a second Prause sockpuppet enters into the fray – “Preceding unsigned comment added by 209.194.90.6“. With so many puppets she can’t keep track of which sockpuppet is editing Wikipedia! By the way, Tgeorescu is clueless and agenda-drive, though not as bad as Nikky P.

May 30, 2018 – Prause falsely accuses Fight The New Drug (FTND) of science fraud, and implies that she has reported Gary to the FBI twice.

This image with a rant by a non-academic is self-explanatory. For the record, Gary has never received notice of any of Prause’s fictitious FBI or police reports, or done anything to merit them, and FTND relies on an array of respected academic scientists and peer-reviewed research. (Addendum: Gary Wilson filed a freedom of information request with the FBI and the FBI confirmed that Prause was lying: no report has ever been filed on Wilson. See – November, 2018: FBI affirms Nicole Prause’s fraud surrounding defamatory claims)

Prause’s claim that “their neuroscience is simply false” is just more fiction from a practiced liar. Prause provides no examples of ‘false neuroscience,” while a reading of a FTND article such as “How Porn Can Become Addictive,” reveals peer-reviewed studies supporting every claim. Another example, found in the FTND FAQs (Is Porn Addiction Even A Real Thing?), contains links to about 200 supporting peer-reviewed papers.

Prause’s falsehoods concerning FTND are exposed in her Salt Lake Tribune Op-Ed attacking FTND. On the surface it appears legitimate as 7 PhD buddies of Prause signed off on it. However, upon closer examination we find that:

It provides no examples of misrepresentation by “Fight The New Drug”, or anyone else.

Some who signed the Op-Ed have histories of fervently attacking the concept of porn and sex addiction (thus demonstrating stark bias).

Most had collaborated with the lead author of the Op-Ed (Prause) or her colleague (Pfaus).

This 600-word Op-Ed is chock full of unsupported assertions meant to fool the lay public. It fails to support a single assertion as it cites only 4 papers – none of which have anything to do with porn addiction, porn’s effects on relationships, or porn-induced sexual problems.

Realizing she’s been exposed, Prause searches SB’s twitter feed for anything she can use, settling for this bizarre personal attack. YBOP has been waiting over 3 years for Prause to name a single study that FTND or Gary Wilson has misrepresented. Still waiting.